Tranexamic Acid In Knee Arthroplasty Research Articles

Tranexamic acid in knee arthroplasty: the effect of preoperative intravenous administration of together with postoperative intravenous maintenance and periarticular administration on bleeding, transfusion, and hospitalization time – a retrospective cohort study

Objective: To compare patients who received preoperative intravenous (IV) plus postoperative maintenance IV tranexamic acid (TXA) therapy and perioperative periarticular TXA to those who did not receive TXA during total knee arthroplasty (TKA) in terms of blood loss, transfusion requirements, and length of hospital stay.
 Material and Method: Data from 194 patients who underwent TKA between 2016 and 2019 were reviewed. A total of 106 patients were included. Twenty-one patients were male, and 95 were female. The patients were divided into three groups: Group 1 (n=37) that did not receive perioperative TXA, Group 2 (n=35) that received preoperative IV and postoperative maintenance TXA therapy, and Group 3 (n=34) that received preoperative IV and perioperative periarticular TXA. The groups were similar regarding demographic data. Statistical comparisons between the groups were made concerning the decrease in hemoglobin levels on postoperative days 1 and 3, the need for transfusion, and the length of hospital stay.
 Results: The mean decrease in hemoglobin on the postoperative first and third days were 1.69(±1.13) and 2.94(±1.14)g/dl, in Group 1, 1.41(±0.99) and 2.44(±1.28)g/dl, in Group 2, and 1.24(±0.83) and 2.21(±0.84)g/dl in Group 3 respectively. The statistical comparison of the hemoglobin decrease revealed a significant difference between Groups 1 and 3 on the postoperative first day(p

Local Versus Intravenous Application of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Study

Local Versus Intravenous Application of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Study

The effects of efficacy of tranexamic acid on postoperative erythrocyte, ALT, AST and FDP

ObjectiveThe study aims at discussing the clinical efficacy of tranexamic acid in knee arthroplasty and its effects on erythrocyte, ALT (alanine aminotransferase), AST (aspartate aminotransferase) and FDP (fibrinogen degradation product) after the operation. MethodTotally, 94 patients who underwent knee arthroplasty in our hospital from June 2015 to June 2017 were randomly divided into the control group and the observation group, with 47 patients, respectively. The patients in the observation group were given tranexamic acid at a dose of 15 mg/kg dissolved in 100 mL normal saline before knee replacement, while those in the control group were given 100 mL normal saline. The dominant blood loss, recessive blood loss, total blood loss, intraoperative blood loss and the drainage, blood transfusion and blood transfusion rate 24 h in postoperative were counted and observed in both groups, and then the differences of HCT (hematocrit), Hb (hemoglobin), ALT, AST and FDP before and 4d after the operation in two groups were compared, to research and analyze the clinical efficacy of tranexamic acid in knee arthroplasty and its effects on erythrocyte, ALT, AST and FDP after the operation. ResultsFirstly, the total blood loss, dominant blood loss, recessive blood loss, intraoperative blood loss, postoperative blood flow, blood transfusion volume and blood transfusion rate in the observation group were lower than those in the control group (P < 0.01). Secondly, the Hb and HCT of the observation group were significantly lower than those of the control group (P < 0.01). Thirdly, ALT, AST and FDP in the two groups were higher than those before operation (P < 0.01). There was no significant difference in ALT, AST and FDP between the observation group and the control group (P > 0.05). ConclusionThe application of tranexamic acid before knee arthroplasty can reduce intraoperative and postoperative blood loss, and do not affect the coagulation function and liver function of patients, and has high drug safety.

Efficacy and safety of topical tranexamic acid in knee arthroplasty

Introduction and objectiveTranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty. Material and methodsA total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomized study. All surgeries were performed under spinal anaesthesia, tourniquet and the same postoperative protocol. Patients were allocated to one of the 3 groups according to the application of TXA: group A (n=30) 1g of topical TXA; group B (n=30) 1g of TXA intravenous and in group C or the control group (n=30) no drug was administrated. Parameters related to blood loss and drain outputs were compared between the 3 groups. ResultsThe results revealed that post-operative decrease in haemoglobin level was significantly lower in group A (1.95g/dL) than group B (2.25g/dL) and group C (2.96g/dL), p<0.01. Total postoperative blood loss was lower in group A (195mL) than group B (466mL) and group C (718mL), p<0.01. There was no significant difference in complications and allogenic blood transfusion rate between the 3 groups. ConclusionsAccording to the results, topical application of 1g TXA significantly reduced blood loss in patients undergoing total knee arthroplasty more than intravenous or no administration of TXA.

EFFICACY OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS IN TOTAL KNEE ARTHROPLASTY.

ABSTRACTObjective:To evaluate the efficacy of tranexamic acid in reducing blood loss in total knee arthroplasty by examining the existing literature. Method:This literature review investigated the use of tranexamic acid in knee arthroplasty. The search was performed in the Pubmed, Science Direct, Google Scholar, and Lilacs databases over a 20-year period using the keywords: “knee arthroplasty, tranexamic acid, and efficacy”. Only randomized clinical trials published between 2000 and 2016 in English, Spanish, or Portuguese were accepted, and only trials which scored above 3 on the Jadad scale were selected. Results:A total of 7 randomized clinical trials met the inclusion criteria, with a sample of 948 patients. Conclusion:The use of tranexamic acid in total knee arthroplasty (unilateral or bilateral) reduces perioperative and postoperative blood loss more than other available antifibrinolytics. With this reduction in total blood loss and the need for blood transfusions without any increase in side effects, the use of tranexamic acid can be considered safe and effective in controlling bleeding after knee arthroplasties. Level of Evidence II; Systematic review.

Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial.

BackgroundTranexamic acid (TXA) is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events.ObjectivesTo verify the prevalence of deep venous thrombosis (DVT) in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug.MethodsAll patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a “topical group” (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release), 30 to an “intravenous group” (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia), and 30 to a control group (100 ml of saline, given at the same time as anesthesia). All patients had duplex ultrasound scans of the legs on the 15th postoperative day.ResultsDeep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group). All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests).ConclusionsBoth topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.

Knee

The August 2015 Knee Roundup360 looks at: Two days as good as three in TKA; Bilateral TKA: minimising the risks; Tranexamic acid in knee arthroplasty: everyone should be using it, but how?; Initial follow-up for knee arthroplasty?; Navigation finds its niche?; Another take on navigation?; Multimodal care for early knee osteoarthritis; ACL graft fixation methods under the spotlight

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen. We studied different dosages, timings, and modes of administration to identify the most effective regimen of tranexamic acid in achieving maximum reduction of blood loss in TKA. We prospectively studied five regimens (four intravenous, one local; 40 patients each) with a control group (no tranexamic acid). The four intravenous (10-mg/kg dose) regimens included (1) intraoperative dose (IO) given before tourniquet deflation, (2) additional preoperative dose (POIO), (3) additional postoperative dose (IOPO), and (4) all three doses (POIOPO). The fifth regimen was a single local application (LA). Two independent parameters of drain loss and total blood loss, calculated by the hemoglobin balance method, were evaluated statistically. Both parameters were reduced in all five regimens as against the control. A significant reduction in drain loss was seen in the POIO, IOPO, and POIOPO groups whereas total blood loss was significantly reduced in the POIO, POIOPO, and LA groups. The POIOPO group had the least drain loss (303 mL) and least total blood loss (688 mL). The IO group had the greatest drain loss and the IOPO group the greatest total blood loss. Single-dose tranexamic acid did not give effective results. The two-dose regimen of POIO was the least amount necessary for effective results. When compared against the control, this regimen produced reduction of drain loss and total blood loss, whereas the IOPO regimen did not. The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss.