Tranexamic Acid In Orthopaedic Surgery Research Articles

Tranexamic acid for bleeding prophylaxis in orthopedic surgery and trauma-standard or customized therapy?

Tranexamsäure hat einen etablierten Stellenwert in der Behandlung von Blutungen, v. a. bei Hyperfibrinolyse. Zunehmend wird TXA auch prophylaktisch bei Trauma und orthopädischen Eingriffen eingesetzt, wobei sich Fragen nach Risiken sowie einem möglichen Off-Label-Einsatz ergeben. Auf Basis der verfügbaren Literatur lässt sich schließen, dass ein prophylaktischer Einsatz des Präparates in diesen Indikationsbereichen vertretbar ist. Jedoch sollte bei Patienten mit erhöhtem Risiko für thrombembolische Ereignisse weiterhin eine individuelle Abwägung von Nutzen und Risiken durchgeführt und dokumentiert werden. Obwohl die Indikationsgebiete des prophylaktischen Einsatzes bei Trauma und orthopädischen Eingriffen nicht spezifisch in der Fachinformation aufgeführt sind, ist die Anwendung unseres Erachtens nicht als Off Label Use zu bewerten.

Tranexamic Acid in Foot and Ankle Surgery: A Topical Review and Value Analysis.

Tranexamic acid (TXA) has become a commonly used perioperative intervention in total joint arthroplasty, shoulder and knee arthroscopy, and spinal procedures in order to minimize blood loss, hematoma formation, hemarthrosis, and wound healing complications. There is a potential role for TXA use in foot and ankle procedures, with limited studies suggesting a potential benefit in minimizing postoperative wound complications and blood loss without an increased risk of thromboembolic events. In light of the profound clinical and financial impact of TXA use in other orthopaedic subspecialties and the early successes in foot and ankle surgery, we aim to provide more information about TXA and its use in foot and ankle surgery. Therefore, the purpose of this review is to perform a comprehensive literature review on the topic of TXA use in foot and ankle procedures in order to describe the pertinent available literature on the use of TXA in orthopaedic surgery and its implications specifically in foot and ankle surgery. It is our aim to identify potential benefits and shortcomings in the available evidence on TXA use for foot and ankle surgery in hopes to (1) best inform foot and ankle surgeons where beneficial and safe and (2) inspire further research on this topic as it relates to clinical management for foot and ankle patients.Levels of Evidence: Level IV.

Tranexamic Acid - Major Antifibrinolytic Agent Used to Achieve Hemostasis in Hemophilic Patients with Anti-Factor VIII Anti-Bodies Who Must Undergo Total Joint Replecement

Hemophilia is a congenital coagulopathy characterized by a deficiency of coagulation factor VIII or IX. The main complication of this hemopathy is represented by the hemorrhagiparous phenomena that affect mainly the musculoskeletal system. Of the various chronic complications of this condition, hemarthrosis is responsible for the onset of chronic arthropathy, which is a disabling condition. In addition to hematologist-prescribed coagulation factor replacement therapy, acute hemarthrosis and chronic arthropathy management requires close collaboration with both orthopedic surgeons and physiotherapists. This multidisciplinary collaboration is essential both to prevent the onset of hemarthroses and to manage acute bleeding episodes, to assess joint function and to effectively treat hemophilic chronic arthropathy. Hemophilic arthropathy causes significant joint instability and reduced mobility or even total ankylosis, which may lead to permanent disability and hence to a decrease in the patient�s quality of life. From an orthopedic point of view, disabling hemophilic arthropathy may be treated by surgery. Achieving effective hemostasis is vital in order to be able to perform these extremely difficult surgical procedures, due to the high risk of bleeding. This paper aims at highlighting the hemostatic efficacy of tranexamic acid in orthopedic surgery in hemophilic patients who must undergo total joint replacement.

Safety of Tranexamic Acid: Are Precautions Needed?

There are a numerous approaches to limit blood loss in orthopedic surgery, including meticulous surgical technique and hemostasis, use of tourniquets, hypotensive anesthesia, and pharmacologic methods such as tranexamic acid (TXA). TXA is an antifibrinolytic drug that has been found to effectively treat several bleeding-related conditions. It has also been used widely among surgical subspecialties because of its effects on hemostasis and ability to reduce transfusion rates. TXA is positively transforming blood management practices with respect to orthopedic surgery. The use of TXA in orthopedic surgery remains off-label use despite the numerous studies demonstrating the benefits of TXA in orthopedic patients. However, there are concerns over potential risks associated with the use of an antifibrinolytic agent during orthopedic surgery because of the inherent risk of thromboembolic events in the perioperative period. In this article, we review the use and safety of TXA in orthopedic surgery to guide clinical practice and blood product management. Complications and evidence for the contraindications of TXA administration are also examined to provide a clear picture of the risks and benefits of using TXA in orthopedic surgery patients.

Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery.

Perioperative bleeding and postsurgical hemorrhage are common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Numerous research studies have reported favorable safety and efficacy in orthopedic cases, although there is no universal standard on its administration and its use has not yet become the standard of practice. Reported administration methods often depend on the surgeon's preference, with both topical and intravenous routes showing efficacy. The type and anatomic site of the surgery seem to influence the decision making but also result in conflicting opinions. Reported complication rates with TXA use are low. The incidence of both arterial and venous thromboembolic events, particularly deep venous thrombosis and pulmonary embolism, has not been found to be significantly different with TXA use for healthy patients. The route of administration and dosage do not appear to affect complication rates either. However, data on patients with higher-risk conditions are deficient. In addition, TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change, and hospital-related costs at various degrees among the published studies. Conservation of blood products, reduced laboratory costs, and shorter hospital stays are likely the major factors driving the cost savings associated with TXA use. This article reviews current data supporting the safety, efficacy, and cost-effectiveness of TXA in orthopedic surgery.

The use of tranexamic acid in joint replacement surgery.

Perioperative bleeding is a prevalent risk of elective joint replacement surgery that can lead to allogeneic blood transfusions, delayed discharge, and slowed physical therapy progress. Antifibrinolytics such as tranexamic acid (TXA) have been used in various surgical procedures to reduce bleeding; however, the use of TXA in orthopaedic surgery is not widespread. The purpose of this article is to determine whether the use of TXA in joint replacement surgery reduces total blood loss and lowers the need for allogeneic blood transfusions without adding additional surgical risk and cost. All reviewed meta analyses and systematic reviews analyzed did show a statistically significant reduction in total blood loss and reduction in the need for allogeneic blood transfusions. Therefore, researchers conclude that intravenous TXA use does decrease total blood loss and allogeneic blood transfusion needs. Thus, its use should be included in orthopaedic clinical practice guidelines due to its overall positive effect on outcomes.

Tranexamic acid in orthopedic surgery

Perioperative bleeding may require blood transfusions, which are sometimes not without complications and risks, with the subsequent increase in health care costs. Among other prevention methods, treatment with tranexamic acid (ATX) has shown to be effective in reducing surgical blood loss, especially in the immediate postoperative period. In this regard, studies evaluating ATX in orthopedic surgery show that it is effective and safe when administered intravenously or intra-articularly. The usual evaluated intravenous doses range between 10mg/kg and 20mg/kg or a fixed dose of 1–2g; while intra-articularly, it varies between 250mg and 3g. ATX, as an anti-fibrinolytic, has a potential thrombotic effect; thus it is contraindicated in those patients at risk or with a history of thrombosis. Its topical administration may be safer, but studies are needed to confirm this.

If You Prick Us, Do We Not Bleed?

If You Prick Us, Do We Not Bleed?