Transfusion In Total Knee Arthroplasty Research Articles

Evaluating the Efficacy and Safety of Combined Administration of Systemic and Topical Tranexamic Acid in Total Knee Arthroplasty.

Tranexamic acid (TXA) is an antifibrinolytic agent, thatagent that reduces substantial blood loss in total knee arthroplasty (TKA) surgeries without increasing the risk of thromboembolic complications. The purpose of our study was to assess the effectiveness and safety of the combined use of intravenousIV and topical TXAtranexamic acid in uncomplicated primary Total knee Arthroplasty (TKA) without complications. In this prospective study, we enrolled 61 patients who underwent unilateral primary TKR and were randomly divided into two groups: Group I received intravenous (IV) TXA and Group II received both IV and intraarticular (IA) TXA. Patients assigned to Group I received IV TXA preoperatively 30 mins before surgery and postoperatively at 3 and 6 hours after surgery, whereas in the combined group, in addition to IV doses, topical TXA was applied as mop 2 g of TXA diluted in 30 mL of isotonic sodium chloride solution) intraarticularly for about 5 minutes before closing the arthrotomy. We measured total blood loss (TBL), ) and mean reduction in haemoglobin (Hb) levels as primary outcomes. Transfusion rates, incidence of thromboembolic events (TE), and other adverse effects as secondary outcomes. Total blood loss TBL and Hb drops was were noted on the 3rd post-operative day. All the patients were followed-up for 6 months to note the incidence of deep venous thrombosisDVT and Thromboembolic Events (TE). An Iindependent t-test was used to evaluate between--group differences. P < 0.05 as is the cut-off for statistically significant differences. The Total blood loss (TBL) in Group I was 780.05 ± 158.05 mL, compared to 660.80 ± 156.45 mL in Group II. (P < 0.001). The Hb drop was significantly lower in IV TXA group (2.3 ± 0.37) than the combined TXA group (1.40 ± 0.32). Furthermore, both groups required no transfusions. No thromboembolic complications was were noted postoperatively and at 6 6-month follow-up. TXATranexamic acid in total knee replacement surgery effectively decreases blood loss and significantly reduces the need for blood transfusions. Based on our study, the combined use of intravenous (IV) and IAintraarticular TXA in total knee replacement was found to be superior in reducing blood loss and significantly reducing the need for blood transfusions in TKA.

Effects of Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty: Meta-Analysis.

The effectiveness of Floseal, a thrombin-based hemostatic matrix, in total knee arthroplasty (TKA) in minimizing blood loss and transfusion requirements remains a topic of debate. This meta-analysis aims to evaluate the up-to-date randomized controlled trials (RCTs) on the efficacy and safety of Floseal in TKA. A comprehensive search was conducted in electronic databases to identify relevant RCTs. The methodological quality of the included studies was assessed, and data extraction was performed. The pooled effect sizes were calculated using standardized mean difference (SMD) or odds ratios (OR) with 95% confidence intervals (CIs). Eight studies involving 904 patients were included in the meta-analysis. The use of a thrombin-based hemostatic agent significantly reduced hemoglobin decline (SMD = -0.49, 95% CI: -0.92 to -0.07) and the risk of allogenic transfusion (OR = 0.45, 95% CI: 0.25 to 0.81) but showed no significant difference in the volume of drainage or total blood loss. Funnel plots showed no evidence of publication bias. This meta-analysis provides robust evidence supporting the effectiveness of Floseal in reducing hemoglobin decline and transfusion in TKA. Further well-designed RCTs with longer follow-up periods are warranted to assess long-term efficacy and safety.

Predictive and protective factors for allogenic blood transfusion in total knee arthroplasty. A retrospective cohort study

BackgroundThis study aimed to identify the predictive and protective factors of blood transfusion in patients undergoing total knee arthroplasty (TKA) and therefore determine the profile of patients with low and high risk of blood transfusion after arthroplasty. MethodsWe conducted a retrospective study with all patients who underwent primary TKA between January 2017 and December 2019 (n = 1.028 patients) in our institution. Information about allogenic transfusion was collected from medical records to determine the incidence, the predictive and protective factors of blood transfusion. All cases of blood transfusions were documented as well the number of units and the moment of each transfusion. We performed univariate and multivariate logistic regression analyses to identify the independent risk and protective factors. ResultsThe total transfusion rate was 11%, 1.1% at intraoperative and 9,9% at postoperative period. The independent risk factors for transfusion were female gender (OR 1.64), older age (>55yo, OR > 2) higher surgical risk (ASA III, OR 3.07), lower preoperative hemoglobin levels (p = 0.024), post-traumatic arthritis (OR 4.11) and use of postoperative drains (OR 1.81) The protective factors for transfusion were male gender (OR 0.60), obesity (IMC >30, OR 0.60) and use of intravenous tranexamic acid intraoperatively (OR 0.40). ConclusionsWe conclude that in addition to the well-established risk factors for blood transfusion such as advanced age, low hemoglobin levels and high surgical risk, we can add post-fracture arthroplasty, non-use of tranexamic acid and the use of postoperative joint drain.

The natural course of hemoglobin levels after allogenic blood transfusion in total knee arthroplasty.

We retrospectively investigated the natural course of hemoglobin levels after allogenic blood transfusion in total knee arthroplasty. All patients were treated according to the same clinical pathway, and blood tests were performed on the same day. All blood tests were done on pre-op, immediate post-op, midnight of op day, 1st, 2nd, 3rd, 5th, 7th, and 11th day after surgery. Of the total 593 cases, a total of 197 cases (33.2%) were performed within 3 days of surgery. Hemoglobin level was significantly lowest on the 3rd day after surgery and tended to increase afterwards in the non-transfusion group. In the case of blood transfusion on the day of surgery, the hemoglobin level showed an increase on the next day and then showed a minimum value on the fifth day of surgery and then increased. The same pattern was identified when blood transfusion was done on the 1st and 2nd day of surgery. However, when blood transfusion was done on the 3rd day, the hemoglobin level showed a steady increase afterwards. The hemoglobin level of total knee arthroplasty patients with no blood transfusion was the lowest on the 3rd day after surgery and increased afterwards. If blood transfusion was done within 2 days after surgery, the hemoglobin level was the lowest on the 5th day after surgery and increased afterwards. If blood transfusion was done on the 3rd day after surgery, the hemoglobin level increased afterwards.

The Effect of Local Tranexamic Acid Administration on Blood Loss and Transfusion in Total Knee Arthroplasty: A Retrospective Study.

The standard surgical method for primary gonarthrosis in advanced stages is total knee arthroplasty (TKA), despite the risk of bleeding that requires transfusion. Blood transfusions are potentially dangerous. The aim of this study was to determine whether there is a statistical difference in the amount of bleeding and the need for transfusion between patients who received and did not receive perioperative local tranexamic acid in TKA. The hospital data system was used to access the data of patients who underwent TKA in our clinic between January 2015 and January 2022 with a diagnosis of gonarthrosis. Patients who underwent TKA and had gonarthrosis as the primary diagnosis were included in the study. They were separated into two groups: A control group (Group C) and a group that received perioperative local tranexamic acid (Group LTXA). The amount of bleeding was compared by taking into account patients' hemogram follow-ups, the amount of blood from their drains, and their transfusion needs during the postoperative period. The findings demonstrated that TKA patients who received local tranexamic acid administration experienced a significant decrease in perioperative blood loss and needed lesser transfusions. The findings of our investigation are consistent with other studies and are in favor of the usage of TXA in TKA. To validate our findings and establish the ideal TXA dosage and administration method in TKA, additional research is required.

The influence of the approach for blood loss and transfusion in total knee arthroplasty: Medial parapatellar vs. subvastus

The influence of the approach for blood loss and transfusion in total knee arthroplasty: Medial parapatellar vs. subvastus

Low muscle mass is an independent risk factor for postoperative blood transfusion in total knee arthroplasty: a retrospective, propensity score-matched cohort study

BackgroundSarcopenia, an age-related loss of skeletal muscle mass and function, is correlated with adverse outcomes after some surgeries. This study examined the characteristics of sarcopenic patients undergoing primary total knee arthroplasty (TKA), and identified low muscle mass as an independent risk factor for postoperative TKA complications.MethodsA retrospective cohort study examined 452 patients who underwent TKA. The skeletal muscle index (SMI) was obtained via bioelectrical impedance analysis (BIA), along with demographics, the Charlson Comorbidity Index, and medication, laboratory and operative data for 2018–2021. Patients were categorized into normal (n = 417) and sarcopenic (n = 35) groups using the SMI cut-off suggested by the Asian Working Group for Sarcopenia 2019 (males, < 7.0 kg/m2; females, < 5.7 kg/m2). Three postoperative complications were analysed: blood transfusion, delirium, and acute kidney injury (AKI). Baseline characteristics were propensity score-matched to address potential bias and confounding factors.ResultsThe proportion of sarcopenic patients in primary TKA was 7.7% (35/452). The sarcopenic group had a lower preoperative haemoglobin (12.18 ± 1.20 vs. 13.04 ± 1.73 g/dL, p = 0.004) and total protein (6.73 ± 0.42 vs. 7.06 ± 0.44 mg/dL, p = 0.001). Propensity scoring matching and logistic regression showed that more patients in the sarcopenic group received postoperative blood transfusions (OR = 6.60, 95% CI: 1.57–45.5, p = 0.021); there was no significant difference in AKI or delirium. Univariate receiver operating characteristic curve analysis of the propensity-matched group, to determine the predictive value of SMI for postoperative transfusion, gave an AUC of 0.797 (0.633–0.96) and SMI cut-off of 5.6 kg/m2.ConclusionsLow muscle mass determined by BIA was an independent risk factor for postoperative transfusion in TKA. Multifrequency BIA can serve as a screening tool for sarcopenia that may influence the orthopaedic decision-making process or treatment planning in patients with sarcopenia undergoing primary TKA.Level of evidenceIII, retrospective cohort study.

A randomized, non-crossover, parallel-group analysis of tranexamic acid in minimizing blood loss and transfusions in total knee arthroplasty

Objectives: Total knee arthroplasty is associated with significant blood loss, necessitating blood transfusions. Due to the obvious risks and costs of allogeneic blood transfusions, techniques to minimize blood loss in surgery are needed. The objective of this study was to assess the efficacy of tranexamic acid treatment in reducing blood loss and blood transfusion requirements during total knee arthroplasty. Materials and Methods: A prospective, randomized, double-blind, parallel-group, non-crossover trial was carried out in Prathima Hospital, Karimnagar. The trial involved 28 ASA I and II patients undergoing unilateral knee arthroplasty, 14 in each of the control and study groups. In the study group, a 10 mg/kg bolus of tranexamic acid was administered slowly IV 30 min before tourniquet deflation, followed by a 1 mg/kg/hr infusion for 12 h, compared to the standard medical treatment in the control group. Total blood loss during and after surgery was compared between the two classes. We also compared the hemoglobin drop after surgery, the number of people who needed blood transfusions, and the number of units needed between the two classes. Any complications were also reported. Results: Total blood loss in the tranexamic acid group was 543.3 ± 184.85 versus 685.83 ± 176.74, a statistically significant difference (P &lt; 0.05). Intraoperative blood loss was comparable, but post-operative blood loss was significantly lower in the tranexamic acid group (389.16 ± 174 ml vs. 514.36 ± 143.89 ml), indicating that it was statistically significant (P &lt; 0.05). There were no complications reported from any of the groups. Conclusion: Tranexamic acid is an effective strategy for minimizing overall blood loss and blood transfusions in patients undergoing total knee arthroplasty.

Reduction of blood loss after total knee arthroplasty by tranexamic acid

Background: Total knee arthroplasty is associated with significant peri-operative blood loss. Various studies have shown that the use of tranexamic acid reduces post-operative blood loss and need for allogeneic blood transfusion in total knee arthroplasty. &#x0D; Objectives: To assess the effect of tranexamic acid in the reduction of the postoperative blood loss in total knee arthroplasty.&#x0D; Methodology: An analytical cross-sectional study was carried out in 14 patients who underwent primary total knee arthroplasty during the study period of 12 months at Kathmandu Medical College. Seven patients were allocated to the case group and received one gram (gm) of tranexamic acid thirty minutes prior to the incision and five hundred milligram (mg) orally three times a day till the drain was removed. Tranexamic acid was not given to the seven patients in control group. The haemoglobin of the patient was recorded on the day of surgery and the total amount of drain output was recorded on postoperative period until the drain was removed.&#x0D; Results: Out of 14 patients operated, it was found that the average amount of drain in the patients in case group was 628 ± 234 millilitre (ml) which was significantly lower than the control group 1028 ± 183 ml (p&lt;0.05). Though there was a difference in the amount of drain output, there was no significant change in the postoperative haemoglobin level in both the groups (p = 0.381). &#x0D; Conclusion: Tranexamic acid, an antifibrinolytic agent, can be effective to reduce blood loss in patients who undergo major surgeries like total knee arthroplasty.

Impact of body mass index on hemoglobin level and blood transfusion in total knee arthroplasty: A retrospective case control study

BackgroundMorbid obesity is a challenge in cases that require total knee arthroplasty, and several studies considered it a contraindication for the procedure due to associated risk of complications, including plummeting hemoglobin levels and subsequent need for a blood transfusion. This study investigated risk factors for blood transfusion in this patient group and considered their relationship to obesity. Materials and methodsPatients’ data were extracted from medical records, including estimated blood loss and perioperative hemoglobin levels. Patients were weighed and measured, and their body mass index (BMI) was calculated and stratified according to international criteria. ResultsA total of 188 patients were included in this study; among them, 136 patients had obesity (72%), with a mean BMI of 33.54. The mean volume of blood lost was 1055.4 ml, with the mean postoperative hemoglobin decrease of 1.42 g/dl and 2.88 g/dl at 6 and 24 h after surgery, respectively. The pre-operative Hb level was the only significant risk factor for blood transfusion. BMI did not affect the risk of blood transfusion or amount of blood lost. ConclusionObesity (BMI > 30 kg/m2) did not increase the risk of needing a blood transfusion after total knee arthroplasty. A judicious transfusion strategy involving the pre-operative Hb optimization should be adopted in TKA to decrease transfusion rate, benefit patient outcomes, and increase healthcare system efficiency. This study shows that high BMI is not a risk factor for postoperative blood transfusion.

Administration of Tranexamic Acid Improves Long-Term Outcomes in Total Knee Arthroplasty

BackgroundBlood transfusion in total knee arthroplasty (TKA) is associated with increased morbidity, including periprosthetic joint infection (PJI). Tranexamic acid (TXA) reduces blood transfusion rates, but there is limited evidence demonstrating improved outcomes in TKA resulting from TXA administration. The objectives of this study are determining whether TXA is associated with decreased rate of PJI, decreased rate of outcomes associated with PJI, and whether there are differences in rates of adverse events. MethodsA multicenter cohort study comprising 23,421 TKA compared 4423 patients receiving TXA to 18,998 patients not receiving TXA. Primary outcome was PJI within 2 years of TKA. Secondary outcomes included revision surgery, irrigation and debridement, transfusion, and length of stay. Adverse events included readmission, deep vein thrombosis, pulmonary emboli, myocardial infarction, or stroke. Adjusted odds ratios were determined using linear mixed models controlling for age, sex, thromboembolic prophylaxis, Charlson comorbidity index, year of TKA, and surgeon. ResultsTXA administration reduced incidence of PJI by approximately 50% (odds ratio [OR], 0.55; P = .03). Additionally, there was decreased incidence of revision surgery at 2 years (OR, 0.66; P = .02). Patients receiving TXA had reductions in transfusion rate (OR, 0.15; P < .0001) and length of stay (P < .0001). There was no difference in the rate of pulmonary emboli (OR, 1.20; P = .39), myocardial infarction (OR, 0.78; P = .55), or stroke (OR, 1.17; P = .77). ConclusionAdministration of TXA in TKA resulted in reduced rate of PJI and overall revision surgery. No difference in thromboembolic events were observed. The use of TXA is safe and improves outcomes in TKA. Level of EvidenceLevel III, Observational Cohort Study.

One Versus Two Doses of Intravenous Tranexamic Acid in Total Knee Arthroplasty.

Tranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary TKA, and received one or two doses of intravenous TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay, rate of deep vein thrombosis or pulmonary embolism (DVT/PE), readmission and reoperation.A total of 1,191 patients were included: 891 received one dose and 300 received two doses. There was no significant difference in rate of transfusion, deep vein thrombosis or pulmonary embolism (DVT/PE), blood volume loss, and reoperation. There was a significantly higher risk of readmission (6.7 vs. 2.4%, odds ratio [OR] 2.96, p < 0.001) and reoperation (2.0 vs. 0.6%, OR 3.61, p = 0.024) in patients receiving two doses. These findings were similar with subgroup analysis of patients receiving only aspirin prophylaxis.In unilateral TKA, there is no difference in transfusion rate with one or two doses of perioperative TXA. There was no increased risk of thromboembolic events between groups, although the two-dose group had a higher rate of readmission and reoperation. Given the added cost without clear benefit, these findings may support administration of one rather than two doses of TXA during primary TKA.

COMPARISON OF EFFICACY OF TRANEXAMIC ACID 10 MG/KG AND 15 MG/KG IN REDUCING BLEEDING AND TRANSFUSIONS IN TOTAL KNEE ARTHROPLASTY

Objective: The objective of this study was to compare the efficacy of tranexamic acid 10 mg/kg and 15 mg/kg in reducing bleeding and transfusions in total knee arthroplasty.&#x0D; Methods: After approval from the Institutional Ethics Committee, KMC, Mangaluru, 88 patients fulfilling the inclusion criteria of this study undergoing total knee replacements were informed of the study details and consent was obtained for the same. They were randomized into two groups using computer-generated block randomization, i.e., Group A and Group B, and were administered tranexamic acid 10 mg/kg and 15 mg/kg intravenously, respectively. Intraoperatively, hemodynamic parameters were noted. Postoperatively, hemoglobin levels were assessed on days 1 and 3. Transfusions, thromboembolic complications, and duration of hospital stay were noted.&#x0D; Results: Of the 88 participants of the trial, 44 in Groups A and B each, there were no significant differences in the parameters observed in this study such as intraoperative hemodynamic changes, post-operative fall in hemoglobin on day 3, number of patients requiring transfusions, number of thromboembolic events, and duration of hospital stay. A significant p-value was observed in the fall in hemoglobin in the post-operative day 3 (p=0.043).&#x0D; Conclusion: About 15 mg/kg tranexamic acid proved to have a lesser fall in hemoglobin on day 3 postoperatively when compared to the 10 mg/kg group. However, the fall of hemoglobin on day 3 was statistically significant and warranted a blood transfusion in two patients in the 10 mg/kg group but did not prolong their hospital stay.

The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis

BackgroundA growing body of published research on tranexamic acid (TXA) suggests that it is effective in reducing blood loss and the risk for transfusion in total knee arthroplasty (TKA). The purpose of this network meta-analysis was to evaluate TXA in primary TKA as the basis for the efficacy recommendations of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine on the use of TXA in primary total joint arthroplasty. MethodsWe searched Ovid MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases for publications before July 2017 on TXA in primary total joint arthroplasty. All included studies underwent qualitative and quantitative homogeneity testing. Direct and indirect comparisons were performed as a network meta-analysis, and results were tested for consistency. ResultsAfter critical appraisal of the available 2113 publications, 67 articles were identified as representing the best available evidence. Topical, intravenous (IV), and oral TXA formulations were all superior to placebo in terms of decreasing blood loss and risk of transfusion, while no formulation was clearly superior. Use of repeat IV and oral TXA dosing and higher doses of IV and topical TXA did not significantly reduce blood loss or risk of transfusion. Preincision administration of IV TXA had inconsistent findings with a reduced risk of transfusion but no effect on volume of blood loss. ConclusionsStrong evidence supports the efficacy of TXA to decrease blood loss and the risk of transfusion after primary TKA. No TXA formulation, dosage, or number of doses provided clearly improved blood-sparing properties for TKA. Moderate evidence supports preincision administration of IV TXA to improve efficacy.

Minimizing Blood Loss and Transfusions in Total Knee Arthroplasty.

Blood loss management is critical to positive outcomes in patients undergoing total knee arthroplasty (TKA). Transfusions are associated with an increased risk of major and minor adverse events, length of hospitalization, and overall cost associated with surgery. Many techniques have been investigated and compared. Tranexamic acid (TXA), an antifibrinolytic drug widely known to reduce blood loss, may be a bridge to the goal of eliminating blood transfusions from TKA. Administration of TXA can be performed intravenously, topically at the knee joint, orally, or in combination. A single bolus or multiple doses have reduced total blood loss and transfusion rates consistently, safely, and cost-effectively. The uptake in use of TXA by surgeons has been slow due to concerns in patients deemed high risk for thromboembolic events. Newer evidence from studies specifically involving high-risk patients demonstrates that TXA is indeed safe in this cohort and provides benefits that greatly outweigh potential risks. Incorporation of TXA as a routine part of TKA is in the best interest of patients, health care teams, and medical institutions. TXA can be employed seamlessly with other blood saving techniques and has the capacity to increase productivity and decrease overall cost. This can be achieved by reducing the incidence of transfusion and length of stay, and the need for practices such as preoperative anemia treatment and suction drainage.

Perioperative Blood Management Strategies for Total Knee Arthroplasty.

Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra-articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period. These benefits improve rehabilitation success and increase patients' postoperative satisfaction. Preoperative anemia, coupled with intraoperative and postoperative blood loss, is a major factor associated with higher rates of blood transfusion in TKA. Thus, treatment of preoperative anemia and prevention of perioperative blood loss are the primary strategies for perioperative blood management in TKA. This review, combined with current evidence, analyzes various methods of blood conservation, including preoperative, intraoperative, and postoperative methods, in terms of their effectiveness, safety, and cost. Because many factors can be controlled to reduce blood loss and transfusion rates in TKA, a highly efficient, safe, and cost-effective blood management strategy can be constructed to eliminate the need for transfusions associated with TKA.

Comparative study of topical vs. intravenous tranexamic acid regarding blood loss in total knee arthroplasty

ObjectiveTo compare topical vs. intravenous tranexamic acid (TA) in total knee arthroplasty regarding blood loss and transfusion. MethodsNinety patients were randomized to receive TA intravenously (20mg/kg in 100mL of saline; group IV), topically (1.5g in 50mL of saline, sprayed over the operated site, before release of the tourniquet; topical group), or intravenous saline (100mL with anesthesia; control group). The volume of drained blood in 48h, the amount of transfused blood, and the serum levels of hemoglobin and hematocrit before and after surgery were evaluated. ResultsThe groups were similar for gender, age, weight, laterality, and preoperative hemoglobin and hematocrit levels (p>0.2). The hemoglobin level dropped in all groups when comparing the preoperative and the 48-h evaluations: the control group decreased 3.8mg/dL on average, while the IV group had a decrease of 3.0, and the topical group, of 3.2 (p=0.019). The difference between the control and IV groups was confirmed by Bonferroni test (p=0.020). The difference between the control group and the topical group was not significant (p=0.130), although there was less reduction in hemoglobin in the topical group; the comparison between the IV group and the topical group was also not significant (p=1.000). ConclusionUsing topic and IV tranexamic acid decreased blood loss and the need for transfusion in total knee arthroplasty. Topical application showed results similar to IV use regarding the need for blood transfusion, but without the possible side effects of IV administration.

Oral Tranexamic Acid Reduces Transfusions in Total Knee Arthroplasty

BackgroundTranexamic acid (TXA) reduces intraoperative blood loss and transfusions in patients undergoing total knee arthroplasty. Although numerous studies demonstrate the efficacy of intravenous and topical TXA in these patients, few demonstrate the effectiveness and appropriate dosing recommendations of oral formulations. MethodsA retrospective cohort study was performed to evaluate differences in transfusion requirements in patients undergoing primary unilateral total knee arthroplasty with either no TXA (n = 866), a single-dose of oral TXA (n = 157), or both preoperative and postoperative oral TXA (n = 1049). Secondary outcomes included postoperative hemoglobin drop, total units transfused, length of stay, drain output, and cell salvage volume. ResultsTransfusion rates decreased from 15.4% in the no-oral tranexamic acid (OTA) group to 9.6% in the single-dose OTA group (P < .001) and 7% in the 2-dose group (P < .001), with no difference in transfusion rates between the single- and 2-dose groups (P = .390). In addition, postoperative hemoglobin drop was reduced from 4.2 g/dL in the no-OTA group to 3.5 g/dL in the single-dose group (P < .01) and to 3.4 g/dL in the 2-dose group (P < .01), without a difference between the single- and 2-dose groups (P = .233). ConclusionOTA reduces transfusions, with greater ease of administration and improved cost-effectiveness relative to other forms of delivery.

Estudo comparativo com uso do ácido tranexâmico tópico e intravenoso em relação à perda sanguínea na artroplastia total do joelho

ObjectiveTo compare topical vs. intravenous tranexamic acid (TA) in total knee arthroplasty regarding blood loss and transfusion. MethodsNinety patients were randomized to receive TA intravenously (20mg/kg in 100mL of saline; IV group), topically (1.5g in 50mL of saline, sprayed over the operated site, before release of the tourniquet; topical group), or intravenous saline (100mL with anesthesia; control group). The volume of drained blood in 48h, the amount of transfused blood, and the serum levels of hemoglobin and hematocrit before and after surgery were evaluated. ResultsThe groups were similar for sex, age, weight, laterality, and preoperative hemoglobin and hematocrit levels (p>0.2). The hemoglobin level dropped in all groups when comparing the preoperative and the 48‐hour evaluations: the control group decreased 3.8mg/dL on average, while the IV group had a decrease of 3.0, and the topical group, of 3.2 (p=0.019). The difference between the control and IV groups was confirmed by Bonferroni test (p=0.020). The difference between the control group and the topical group was not significant (p=0.130), although there was less reduction in hemoglobin in the topical group; the comparison between the IV group and the topical group was also not significant (p=1.000). ConclusionUsing tranexamic acid topic and an IV decreased blood loss and the need for transfusion in total knee arthroplasty. Topical application showed results similar to using an IV regarding the need for blood transfusion, but without the possible side effects of IV administration.

Combination Intravenous and Intra-Articular Tranexamic Acid Compared with Intravenous Only Administration and No Therapy in Total Knee Arthroplasty: A Case Series Study

IntroductionExcessive perioperative bleeding requiring transfusion remains a potential complication of Total Knee Arthroplasty (TKA). There is overwhelming evidence supporting the efficacy of intravenous Tranexamic acid to reduce bleeding and the need for transfusion in TKA. There is still some question regarding the efficacy of other methods of Tranexamic acid administration. This case series study evaluated the effects of the use of intravenous Tranexamic acid administered alone, or in combination with intra-articular tranexamic acid on transfusion rate and other clinical outcomes; and compared this to a group of patients who received neither treatment.MethodWe conducted a case review of 150 patients who had undergone TKA from 2012-2015. 50 patients underwent TKA with IV Tranexamic acid (Group A). A further 50 patients underwent TKA with IV Tranexamic acid in combination with intra-articular administration of 2grams of Tranexamic acid in 20ml saline (Group B). A final 50 patients underwent TKA without the use of Tranexamic acid (non-treatment group). Outcome measures were transfusion rate, change in haemoglobin and haematocrit, medical review events, patient mortality and changes in knee flexion and extension measurements at six weeks after surgery.ResultsThere were no significant differences in red blood cell transfusion rates between the non-treatment group and the two treatment groups, however an absolute reduction in transfusion rate from 8% to 0% (p=0.134) was observed. The mean change of haemoglobin level in the non-treatment group was 29 while in treatment groups A and B, this was 23 and 19 respectively (p=0.0001). No significant difference was observed between treatment group A and B. There was a significant difference in post-operative haemoglobin level, where mean haemoglobin concentrations in non-treatment, Group A and B were 110 vs 115 vs 123 respectively (P= 0.0001). Pairwise comparison showed that Group B was significantly different when compared to both non treatment (p=0.0001) and treatment group A (p=0.020). There were no significant differences observed in other outcomes.ConclusionThis study supports the existing literature and suggests that the use of IV Tranexamic acid alone or in combination with intra-articular dose in TKA may reduce the requirement for transfusion (Level IV evidence). Furthermore, this study suggests that the use of tranexamic acid as a combination of Intravenous and intra-articular administration has no effect on range of motion, or medical complications during hospital stay. Although it was not a statistically significant finding, our study suggested a trend towards a greater reduction in haemoglobin and haematocrit fall in the combination therapy group when compared to IV Tranexamic acid alone