Perioperative Use Of Tranexamic Acid Research Articles

Perioperative use of tranexamic acid in elderly patients undergoing hemiarthroplasty for neck of femur fractures: Is it worth using in every patient? An updated systematic review and Meta-analysis

Hemiarthroplasty becomes the procedure of choice for hip fracture in elderly population with blood loss as its complication. Tranexamic acid (TXA) has been used with no systematic review conducted to evaluate its efficacy and safety. The PRISMA guidelines were followed to conduct literature screening and selection. Main outcomes were extracted for qualitative analysis and quantitative analysis. Blood loss level and haemoglobin drop was significantly reduced in TXA group as compared to the control group. TXA is also deemed as protective factor for transfusion requirement. TXA use may be considered in every patient undergoing hemiarthroplasty procedure unless absolute contraindication exists.

Efficacy and safety of tranexamic acid in elderly patients with femoral neck fracture treated with hip arthroplasty: A systematic review and meta-analysis

BackgroundElderly patients with femoral neck fracture have high perioperative blood loss according to the trauma and hip arthroplasty surgery. Tranexamic acid is a fibrinolytic inhibitor and has been widely used in hip fracture patients to against perioperative anemia. The aim of the present meta-analysis was to evaluate the efficacy and safety of Tranexamic acid (TXA) in elderly patients with femoral neck fracture undergoing hip arthroplasty. MethodsWe performed search using Pubmed, EMBASE, Cochrane Reviews, and Web of Science databases to identify all relevant research studies published from inception to June 2022. Randomized controlled studies and high-quality cohort studies that reported the perioperative use of TXA in patients with femoral neck fractures treated with arthroplasty, and made a comparison with the control group were included. Meta-analysis was performed using Review Manager 5.3 to assess the efficacy and safety of TXA. Subgroup analysis was conducted to further investigate the impact caused by surgery types and administration routes on the efficacy and safety outcomes. ResultsFive randomized controlled trials (RCTs) and eight cohort studies published from January 2015 to June 2022 were included in this meta-analysis. The results showed significant reductions in the rate of allogeneic blood transfusion, total blood loss (TBL) and postoperative hemoglobin (Hb) drop in the TXA group compared with the control group, while no significant difference was found in the intraoperative blood loss, postoperative drainage, hospital length of stay (LOS), re-admission rate, and wound complications between the two groups. The incidence of thromboembolic events and mortality showed no significant difference. Subgroup analysis indicated that surgery types and administration routes did not change the overall tendency. ConclusionThe current evidence shows that both intravascular administration (IV) and topical administration of TXA can significantly decrease the perioperative transfusion rate and TBL without increasing the risk of thromboembolic complications in elderly patients with femoral neck fracture.

Predisposing factors for allogeneic blood transfusion in patients with ankylosing spondylitis undergoing primary unilateral total hip arthroplasty: a retrospective study

BackgroundThe transfusion rate is relatively high in patients with ankylosing spondylitis (AS) undergoing total hip arthroplasty (THA). However, relevant studies focusing on the predisposing factors for transfusion with a large sample size are lacking. This study aimed to investigate the incidence of and risk factors for allogeneic blood transfusion in patients with AS undergoing primary unilateral THA.MethodsThis retrospective study included 331 patients with AS who underwent primary unilateral THA between 2011 and 2021. Relevant parameters were collected through a chart review. Multivariate logistic regression analysis was conducted to identify possible factors associated with perioperative allogeneic blood transfusion.ResultsA total of 113 (34.1%) patients received perioperative allogeneic blood transfusions. Factors related to receiving an allogeneic blood transfusion included prolonged operative duration (odds ratio [OR] per 10 min = 1.139, P = 0.047), increased estimated intraoperative blood loss (OR per 100 mL = 1.348, P < 0.001), and increased postoperative drainage volume (OR per 100 mL = 1.235, P = 0.024). A higher body mass index (BMI) (OR = 0.914, P = 0.012), perioperative tranexamic acid (TXA) use (OR = 0.166, P < 0.001), and a higher preoperative hemoglobin level (OR per 1 g/dL = 0.744, P = 0.004) decreased the risk of transfusion.ConclusionsIn patients with AS undergoing THA, prolonged operative duration, increased estimated intraoperative blood loss, and increased postoperative drainage volume were found to be risk factors for transfusion, whereas a higher BMI, perioperative TXA use, and a higher preoperative hemoglobin level were protective factors. These results may aid in developing a better perioperative management strategy, ultimately reducing the need for transfusion.

Tranexamic Acid Use in Breast Surgery: A Systematic Review and Meta-Analysis.

The perioperative use of tranexamic acid (TXA) has become popular among plastic surgeons for a variety of surgical procedures. The aim of this study was to perform a systematic review and meta-analysis on the results reported in the literature regarding the effect of perioperative systemic TXA administration in breast surgery. The PubMed, MEDLINE, Embase, CENTRAL, and CINAHL databases were searched for both randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio with corresponding 95% confidence interval. A total of five studies encompassing 1139 patients undergoing mastectomy with or without immediate implant or free flap-based breast reconstruction or breast-conserving surgery with or without axillary lymph node dissection were included. Perioperative intravenous administration of TXA significantly reduced the risk for hematoma (7.3% versus 12.9%; OR, 0.43; 95% CI, 0.23 to 0.81) and seroma formation (11.5% versus 19.9%; OR, 0.57; 95% CI, 0.35 to 0.92) in comparison to the control group. In the studies measuring the postoperative drainage amount, the mean difference was 132 mL (95% CI, 220 to 44 mL). No thromboembolic event occurred in either group. The weighted surgical-site infection rate was higher in the control group (3.1% versus 1.5%). However, these data were too sparse to perform comparative meta-analysis. Evidence of this study suggests that perioperative administration of TXA significantly reduces the risk for postoperative hematoma and seroma formation in breast surgery, whereas the risk for thromboembolic events and postoperative infection is not increased.

Tranexamic acid use in breast surgery: A systematic review

Background: Tranexamic acid (TXA) has revolutionised the management of bleeding in trauma and surgery. Postoperative bleeding in breast surgery can have significant adverse patient implications. The resulting psychological, aesthetic, financial and physiological morbidity may be mitigated with the perioperative use of TXA. This systematic review aims to evaluate the efficacy and safety of TXA in breast surgery in preventing postoperative bleeding-related complications.

Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess efficacy and safety of tranexamic acid (TXA) use in acute traumatic injuries. PubMed and Cochrane libraries were searched for relevant RCTs published between January 2011 and January 3, 2021. Cohen's Q Test for heterogeneous effects was used to determine the appropriateness of fixed versus random effects models. Twenty-two studies met inclusion criteria. Meta-analysis of relative risk of mortality between treatment and placebo groups in the in-hospital, and perioperative settings was not significant. However, the risk of mortality is significantly lower in the treatment versus placebo group when TXA was given as loading dose only. Ten of the 11 studies evaluating perioperative use of TXA included in systematic review found significantly lower blood loss in the treatment compared with placebo groups, but results of meta-analysis showed no significant difference. Results of meta-analysis indicate that the risk of venous thromboembolism (VTE) in the in-hospital treatment group is greater than that of the placebo. In subset analysis of studies using only a single loading dose, there were no significant differences in VTE. Systematic review supports TXA benefits are most evident when given shortly after injury and meta-analysis supports TXA reduces mortality as a single loading dose. Systematic review supports perioperative use of TXA when large volume blood loss is anticipated. Meta-results showed no significant difference in risk of thromboembolism in single-dose TXA treatment compared with placebo. These findings suggest that TXA is safe and effective for control of traumatic bleeding.

New and Off-Label Uses of Tranexamic Acid.

New and Off-Label Uses of Tranexamic Acid.

Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): study protocol for a multicentre randomised, blind, placebo-controlled trial

IntroductionPancreaticoduodenectomy (PD) is a major gastroenterological surgery that results in a substantial amount of blood loss. Several studies have demonstrated that major blood loss during PD is associated with both...

Tranexamic Acid Use in Foot and Ankle Surgery.

Background:There is a potential role for tranexamic acid (TXA) use in foot and ankle procedures; however, the benefits of this intervention have not been fully elucidated. The purpose of this study was to explore the safety, outcomes, and medical complication profile of the use of intravenous TXA in patients undergoing foot and ankle surgery.Methods:A prospective study with retrospective review of 241 patients undergoing elective and traumatic foot and ankle procedures was performed. One gram of intravenous (IV) TXA was administered prior to incision. Patients were followed and evaluated for medical comorbidities, intraoperative blood loss, wound complication, superficial and deep infections, hematoma formation, medical complications, 30-day hospital readmission rate, and return visits to the emergency department or urgent care setting prior to first postoperative visit. Descriptive statistics were used for subgroup analysis. Mean postoperative follow-up was 4.5 months.Results:Estimated blood loss in all cases was less than 20 mL. There was 1 case of superficial cellulitis (1/241, 0.4%), 1 deep infection after Achilles tendon repair (1/241, 0.4%), 4 cases of delayed wound healing (4/241, 1.6%), 1 instance of deep vein thrombosis (1/241, 0.4%), and 2 cases of postoperative pulmonary embolism (2/241, 0.8%). There were no instances of postoperative hematoma formation. There were no additional recorded thromboembolic events. There were no adverse drug reactions. There were no 30-day hospital readmissions or return visits to the emergency department or urgent care setting before the first postoperative visit. In a subgroup analysis, there was no significant difference in wound complications or infections between nondiabetics and diabetics (P > .05) and traumatic and nontraumatic cases (P > .05).Conclusions:The use of IV TXA in foot and ankle surgeries was associated with low risk of wound complications, infections, hematoma formation, thromboembolic events, and overall complication rates with minimal side effect profile. Perioperative tranexamic acid use may prove to be beneficial in foot and ankle surgery patients but especially in higher-risk patients such as those with diabetes, trauma, and those that are immunocompromised.Level of Evidence:Level IV, case series.

A Single Preoperative Dose of Tranexamic Acid Reduces Perioperative Blood Loss: A Meta-analysis.

To review the efficacy and safety of a single dose of intravenous tranexamic acid (TXA) given preoperatively. TXA is a synthetic antifibrinolytic that has been used in various surgical disciplines to reduce blood loss, blood transfusions, ecchymosis, and hematoma formation. However, there is no universal standard on the most effective dose and route of TXA administration, limiting its routine use in many centers. This study evaluates the current evidence for the efficacy and safety of a single preoperative dose of TXA on surgical blood loss in all surgical disciplines. With the guidance of a research librarian, in accordance with the Cochrane Handbook Medline, Cochrane Central and Embase were searched in November 2018. Search terms included "Tranexamic Acid" AND "Intravenous," with studies limited to randomized controlled trails in adult humans. Two independent reviewers and an arbitrator assessed articles for inclusion. Criteria included a single preoperative bolus dose of intravenous TXA, surgical patients, and intraoperative blood loss measurement or perioperative blood loss up to 24 hours postsurgery. Quality assessment was done using the Cochrane Collaboration risk-of-bias tool by 2 reviewers. Statistical analysis was carried out using Cochrane Review Manager 5.3. The primary outcome was surgical blood loss. Secondary outcomes included venous thromboembolic complications, transfusion requirements, and dosing. A total of 1906 articles were screened, 57 met inclusion criteria. The majority of included studies were orthopedic (27), followed by obstetric and gynecological (16), oral maxillofacial and otolaryngology (10), cardiac (3), and 1 plastic surgery study focusing on acute burn reconstruction. Across all surgical specialties (n = 5698), the perioperative estimated blood loss was lower in patients receiving TXA, with a standard mean difference of -153.33 mL (95% CI = -187.79 to -118.87). Overall, surgical patients with TXA had a 72% reduced odds of transfusion (odds ratio = 0.28 [95% CI = 0.22-0.36]). The most frequently used dose of TXA was 15 mg/kg. There was no difference in the incidence of venous thromboembolic events between TXA and control groups. While there is a growing body of evidence to support benefits of perioperative TXA use, this is the first meta-analysis to identify the efficacy and safety of a single preoperative dose of IV TXA. The potential implications for expanding the use of preoperative TXA for elective day surgery procedures is substantial. Preoperative intravenous TXA reduced perioperative blood loss and transfusion requirements in a variety of surgical disciplines without increasing the risk of thromboembolic events. Therefore, it should be considered for prophylactic use in surgery to reduce operative bleeding.

Does perioperative use of tranexamic acid in hip fracture patients increase the risk of venous thromboembolism and reduce the need for postoperative transfusions?

Perioperative tranexamic acid use is a popular choice among many surgeons for reducing surgical blood loss and its sequelae. While there is evidence in the literature that tranexamic acid use is effective in reducing blood loss in surgery for patients with hip fractures, there is less information on whether it leads to thromboembolic complications. We undertook a retrospective study in patients with hip fractures at two local hospitals to investigate if there was an increased risk of venous thromboembolism in patients who received tranexamic acid, and whether it reduced perioperative blood loss and the need for transfusion. We found that tranexamic acid used in patients undergoing hip fracture surgery reduced the drop in postoperative haemoglobin and the need for postoperative blood transfusion but was not associated with an increased risk of venous thromboembolism.

Exclusion criteria and adverse events in perioperative trials of tranexamic acid: a systematic review and meta-analysis.

Tranexamic acid (TXA) is an inexpensive therapy effective at minimizing perioperative blood loss and transfusion. However, it remains underutilized due to safety concerns. To date, no evidence-based guidelines exist identifying which patients should not receive TXA therapy. This study determined patient groups for whom safety information regarding TXA is lacking due to common exclusion from perioperative TXA trials. A systematic review searching the databases Medline, EMBASE, CENTRAL, and Clinicaltrials.gov was performed. Randomized controlled trials (RCTs) administering systemic TXA perioperatively to elective or emergent surgery patients were eligible. Our primary outcome was to describe exclusion criteria of RCTs, and the secondary outcome was TXA safety. A descriptive synthesis of exclusion criteria was performed, and TXA safety was assessed by meta-analysis. A total of 268 eligible RCTs were included. Meta-analysis showed that systemic TXA did not increase risk of adverse events compared to placebo or no intervention (relative risk, 1.05; 95% confidence interval, 0.99-1.12). Patient groups commonly excluded from perioperative TXA trials, and thus potentially lacking TXA safety data, were those with major comorbidities, a history of thromboembolism, medication use affecting coagulation, TXA allergy, and coagulopathy. Exclusion of patients with major comorbidities may not be necessary; we showed that the risk of adverse events was similar in studies that excluded patients with major comorbidities and those that did not. Sufficient evidence exists to develop perioperative guidelines for TXA use in many populations. Further studies evaluating perioperative TXA use in patients with a history of thromboembolism are warranted.

Comparison between Our Results in the Maturity Assessment Patient Blood Management (MAPBM) Project and Other 34 National Hospitals

INTRODUCTIONAllogeneic red blood cell (RBC) transfusions are vital and effective and effective to treat anemia. RBC transfusions increase hospitalizations in 2.5 days, risk of death in 1.7 times and risk of infection in 1.9 times. The cost of discharges from the hospital is 1.83 times higher and it represents 7.8% of the hospitalization total expenses. However, there is little awareness and knowledge about this transfusion practice, as well as an inexplicable and enormous inter-center variability.In attempt to reduce unnecessary transfusions and improve postoperative evolution, as well as to reduce hospital costs, “Patient Blood Management” (PBM) program has been developed, which includes hospital policies, procedures and protocols. In literature, evidence of PBM programs effectiveness is growing.METHODIn view of the need to evaluate these issues, the Maturity Assessment Patient Blood Management (MAPBM) project was constituted in 2014, which involves a group of clinical and management experts nationwide, with the participation of 35 Spanish hospitals (including our center since 2015). It evaluates and compares:•The knowledge of professionals about transfusion practice and PBM programs (anonymous survey). Figure 1.•The PBM process indicators of each participating center. Figure 2.•Inter-transfusion variability and factors related to transfusion in different procedures adjusted by age, sex and comorbidity. Figure 3We will analyze the results of our center comparing them with the rest of hospitals.RESULTSIn general, there is a high awareness of the indication and minimization of transfusions in different procedures, as well as a dissemination of our PBM programs above the average, especially the protocol of preoperative anemia (Figure 1).Despite this, the results of our circuit for the correction of preoperative anemia are unfavorable, since they are detected in a higher percentage than the rest of the centers, but they are not effectively treated in the studied procedures (Figure 2).Our strategies to minimize bleeding, both spinal anesthesia in orthopedic and traumatological surgeries and perioperative use of tranexamic acid are noteworthy, except in the cases of hip fracture surgeries, where its use was contraindicated by multidisciplinary consensus.Our transfusion threshold is close to the standard. In all the studied procedures, transfusion with Hb ≥ 8gr / dl is not considered.Regarding the results of transfusion and factors related to transfusion (Figure 3), a globally superior transfusion rate is observed, mainly at the expense of cardiac and open colorectal surgery.Regarding other items, our mortality and complications rates are, in general, unfavorable. However, hospitalizations and readmissions are lower.CONCLUSIONSAlthough the dissemination of our PBM strategies is adequate, its implementation has not meant an improvement in the transfusion rate of the procedures studied, being even higher than the expected rate.We assume that the lack of efficacy of the circuit for the correction of preoperative anemia is due to the intrinsic obstacles of our center. Among them:•Premature programming in some patients, especially the case of cardiovascular surgery, which determines that the time between the surgical indication and the preoperative visit, is very limited.•Lack of adequacy of the treatment at the date of intervention caused by lack of knowledge, especially in general surgery.•The rigid criteria for the delivery of carboxymaltose iron limit the inclusion of patients who are closer to the intervention date, or determine an insufficient dosage of iron sucrose.•Lack of diffusion of our program to different services when correcting postoperative anemia with iron.Strategies will be established by the Transfusion commission to solve the problems identified.As for the unfavorable results on transfusion practice (transfusion index, mortality and complications), it is essential to introduce improvements and update the optimal use of blood products by our professionals.This contradicts the results of the Transfusion Practice Survey. Therefore, we will take this data with caution, insisting on the awareness of adequate transfusion policies and PBM strategies, with the support of the hospital's management, and the dissemination of knowledge about these programs to achieve the commitment of the professionals involved. DisclosuresNo relevant conflicts of interest to declare.

Perioperative Tranexamic Acid Treatment and Risk of Cardiovascular Events or Death After Total Hip Arthroplasty: A Population-Based Cohort Study from National Danish Databases.

There have been concerns that the antifibrinolytic drug tranexamic acid (TXA) might increase the postoperative risk of cardiovascular events. Our objective was to determine whether perioperative TXA use is associated with cardiovascular events and death within 30 days after primary total hip arthroplasty (THA). We conducted a nationwide cohort study of cardiovascular outcomes after perioperative exposure to tranexamic acid during THA. We included 45,290 patients who had a THA in the study period of 2006 to 2013; 38,586 received perioperative TXA, and 6,704 did not. Propensity scores were calculated on the basis of age, sex, income, year of surgery, Elixhauser comorbidity index, and a variety of comorbidities and coprescribed medications. The primary outcome was venous thromboembolism. The secondary outcomes were deep venous thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, and all-cause mortality. Data were analyzed using Cox regression, either in a multivariable model with inclusion of covariates (full cohorts) or in propensity-score-matched cohorts. After propensity score matching, all prognostic covariates balanced well. In the matched cohort, TXA use was not found to significantly increase the risk of venous thromboembolism (hazard ratio [HR] = 1.18; 95% confidence interval [CI] = 0.83 to 1.68), deep vein thrombosis (HR = 1.15; CI = 0.78 to 1.68), pulmonary embolism (HR = 1.50; CI = 0.60 to 3.78), myocardial infarction (HR = 0.83; CI = 0.46 to 1.50), ischemic stroke (HR = 0.89; CI = 0.39 to 2.01), or all-cause mortality (HR = 0.73; CI = 0.41 to 1.28). Similar results were found in the multivariable Cox regression analyses. Our data do not support a detrimental effect of TXA on the risk of cardiovascular events or death following THA. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The use of tranexamic acid in microsurgery—is it safe?

An appropriate and adequate blood flow and oxygen delivery is paramount to free flap viability and success. The perioperative use of tranexamic acid (TXA) is associated with less risk for blood loss and blood transfusion in trauma, gynaecology, ear nose and throat (ENT) and orthopaedic surgery. As an antifibrinolytic drug, TXA has generally been avoided in microsurgery. The aim of this study is to evaluate the safety and benefit of using TXA in microsurgery. We performed a retrospective single centre cohort study at the Pyramid Clinic, Zurich, Switzerland, including 98 free tissue transfers for breast reconstruction from 2011 to 2013. According to the estimated blood loss, up to 3 g TXA were administered intravenously in 63 free flaps perioperatively. No thrombosis (0%) of micro-anastomosis and 5 haematomas (10.0%) occurred after administration of TXA. In the control group, 1 thrombosis (3.0%) of a flap-vein and 6 haematomas (18.2%) occurred. Blood loss was significant lower (P<0.001) after administration of TXA. In this study, administration of TXA did not increase thrombosis in free tissue transfer and showed a reduced haematoma rate and significant reduction of blood loss. TXA is supposed to be safe and a reasonable adjunct for patients with anaemia and a higher intraoperative or postoperative blood loss.

Comparison of Effects of Tranexamic Acid and Transcollation on Blood Loss in Total Knee Arthroplasty

Background: Perioperative use of tranexamic acid (TXA) reduces blood loss during a total knee arthroplasty (TKA). Transcollation using Aquamantys is a radiofrequency bipolar hemostatic sealing technology which prevents postoperative hemarthrosis. A comparison between TXA and transcollation using Aquamantys on the effect of perioperative blood loss in TKA has not yet been reported. Methods: This is a retrospective cohort study. Two groups of patients underwent unilateral TKAs: TXA group and Aquamantys group. There were 92 patients in the TXA group and 96 patients in the Aquamantys group. The mean drop in hemoglobin levels between the preoperative and postoperative periods in the TXA group and Aquamantys group were compared using unpaired t test. Also, the proportion of cases in the TXA group and Aquamantys group that had a blood hemoglobin drop of≥4 gm/dL was calculated and the odds ratio of such an outcome among the 2 groups was analyzed. Results: The mean preoperative hemoglobin levels (gm/dL) in the TXA and Aquamantys groups were comparable. The mean (range) preoperative hemoglobin levels (gm/dL) in the TXA group and Aquamantys group were 13.2 (9.1 to 16.6) and 13.5 (11.3 to 16.6), respectively (P=0.51). The mean (range) postoperative hemoglobin levels (gm/dL) in TXA group and Aquamantys group were 10.9 (8.2 to 13.9) and 10.6 (7.2 to 13.1), respectively (P=0.55). The mean drop of hemoglobin levels (gm/dL) between the preoperative and postoperative period in the TXA group and Aquamantys group were 2.3 and 2.9, respectively (P=0.0016). More importantly, compared with 4 patients in the TXA group, 18 patients in the Aquamantys group had a perioperative hemoglobin drop of&gt;4 gm/dL which is significant (odds ratio, 5.14; 95% confidence interval, 1.66-15.8; z statistic, 2.85; P=0.004). Conclusions: Use of TXA during primary unilateral TKA is statistically more effective compared with Transcollation using Aquamantys both in terms of mean drop of hemoglobin perioperatively and also in decreasing the proportion of patients that develop perioperative hemoglobin drop of &gt;4 gm/dL, of which the latter finding is also clinically significant. Level of Evidence: Therapeutic Level III—see instructions for authors for a complete description of levels of evidence.

An international based survey on perioperative use of tranexamic acid in neurotrauma

Abstract Background: Tranexamic acid is used to reduce bleeding, easy to use, affordable and relatively safe. There are few studies on the use of tranexamic acid in trauma and especially in neurosurgery. There is no published study on the trend the use of tranexamic acid in neurotrauma surgery among international doctors. The aim of this study was to evaluate the current practice for use of tranexamic acid during neurotrauma surgery. Materials and Methods: A 11-question electronic survey was sent to 25 practicing physicians worldwide. Basic demographic information and estimated rates of use of tranexamic acid during neurotrauma surgery. Results: Twenty five physicians responded to our survey. Very Few trusts (12%) use tranexamic acid during neurotraumasurgery. Conclusion: Further studies are required to establish guidelines in neurosurgery and neurotrauma, especially. The use of this medicine potentially helps improve patient care with head injury and save lives.

Tranexamic acid and orthopedic surgery-the search for the holy grail of blood conservation.

Over the last decade an increasing amount of literature regarding the perioperative use of tranexamic acid (TXA) for bleeding control in orthopedic surgery has been published (1-6). While clinical trials found promising results regarding the reduction of blood loss and therefore a reduced rate of blood transfusions, concerns regarding prothrombotic adverse events including deep vein thrombosis, myocardial infarction, pulmonary embolism and cerebrovascular events have continued to dampen the enthusiasm and thus recommendations for wide spread use (7).

Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety

Objective To determine the effectiveness and safety of perioperative tranexamic acid use in patients undergoing total hip or knee arthroplasty in the United States.Design Retrospective cohort study; multilevel multivariable logistic...

Combined perioperative use of tranexamic acid with a postoperative reinfusion/autotransfusion drainage system dramatically decrease the allogenic transfusion needs in total knee arthroplasty (TKA)

Combined perioperative use of tranexamic acid with a postoperative reinfusion/autotransfusion drainage system dramatically decrease the allogenic transfusion needs in total knee arthroplasty (TKA)