Intra-Articular Tranexamic Acid Mitigates Blood Loss and Morphine Use After Total Knee Arthroplasty. A Randomized Controlled Trial

Background

Tranexamic acid (TXA) has been widely used in total knee arthroplasty (TKA) for blood loss reduction. Given limited evidence on potential relationship between the TXA and improvement of pain control and functional outcome after TKA, this study aimed at comparing the blood loss, pain scores, morphine consumption, and knee flexion across the TXA administration routes.

Intravenous vs Intra-Articular Tranexamic Acid in Total Knee Arthroplasty: A Randomized,Double-Blind Trial

Background

Tranexamic acid (TXA) is commonly used in primary total knee arthroplasty (TKA); however, the most appropriate route of administration is still debated. This study was conducted to compare the 2 most commonly used routes of TXA administration, intravenous (IV) and intra-articular (IA).

Combination of Intravenous and Topical Application of Tranexamic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

This study was aimed to determine the efficacy and safety of combined intravenous (IV) and topical application of tranexamic acid (TXA) in unilateral total knee arthroplasty (TKA) compared with the IV-TXA. One hundred eight-four patients were enrolled. Participants received either 3 g of IV-TXA or 1.5 g topical TXA combined with 1.5 g IV-TXA. The results revealed that compared with the 3 g IV-TXA, adding 1.5 g topical TXA to 1.5 g IV-TXA in unilateral TKA can have the similar effectiveness in reducing transfusion rate and total blood loss without sacrificing safety. The most important is that by adding topical TXA, patients can gain a smaller maximum decline of hemoglobin (Hb), less drainage volume, less postoperative knee pain, less knee swelling, shorter length of hospital stays and higher short-term satisfaction.     

Intra-articular Application is More Effective Than Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Background

The optimal administration route of tranexamic acid (TXA) in total knee arthroplasty (TKA), and the effect of TXA on hidden blood loss and total blood loss are undetermined. The purpose of this study was to compare the effectiveness of intravenous versus intra-articular application of tranexamic acid in patients undergoing knee arthroplasty.

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

Background

A 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.

Oral Tranexamic Acid Reduces Transfusions in Total Knee Arthroplasty

Background

Tranexamic 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.

The Effect of Tranexamic Acid on Blood Loss and Transfusion Rate in Primary Total Knee Arthroplasty

Allogeneic blood transfusions remain common in primary total knee arthroplasty. We reviewed our experience with 2269 consecutive primary total knee arthroplasties in 2069 patients over a 3.5 year period. In our cohort, 1838 received no TXA, 330 received TXA via IV infusion, and 130 had TXA applied topically. The need for blood transfusion, as well as hematocrit levels immediately after surgery in the recovery room and the day of discharge were recorded. Tranexamic acid infusion demonstrated a statistically significant decrease in blood transfusion (P = 0.001), as did topical application of TXA (P = 0.019). The transfusion rate without TXA was 6.5% (120/1839) but only 0.3% (1/330) with TXA infusion. There were no transfusions (0/130) with topical TXA. Statistical differences were also noted in both immediate post operative and day of discharge hematocrit levels in patients having TXA infusion while those values for patients with TXA irrigation failed to obtain statistical significance. No significant change in the rate of symptomatic deep venous thrombosis or pulmonary embolism was noted.     

Comparison Between Intravenous and Intra-articular Regimens of Tranexamic Acid in Reducing Blood Loss During Total Knee Arthroplasty

Tranexamic acid is an antifibrinolytic drug used widely to prevent bleeding. Its use in reducing bleeding during total knee arthroplasty surgery is well proven but there is no final consensus regarding the regimen. The purpose of our study was to compare the effectiveness of intravenous and intra-articular regimen of tranexamic acid during the total knee arthroplasty surgery. A total of 40 patients were received three doses of intravenous tranexamic acid during total knee arthroplasty surgery. Intra-articular tranexamic acid was used in 40 patients during the surgery. We concluded that intra-articular tranexamic acid is equally effective as three dose intravenous regimen in reducing blood loss during total knee arthroplasty surgery.     

Topical Administration of Tranexamic Acid in Primary Total Hip and Total Knee Arthroplasty

Major blood loss is a known potential complication in total hip and total knee arthroplasty. We conducted a prospective, stratified, randomized, double-blind, placebo-controlled trial that evaluated 100 patients undergoing total knee or total hip arthroplasty to evaluate the effect on blood loss using the topical application of tranexamic acid. Participants received either 2 g of topical tranexamic acid or the equivalent volume of placebo into the joint prior to surgical closure. Tranexamic acid resulted in a lower mean maximum decline in postoperative hemoglobin levels when compared to placebo (P = 0.013). Patients in the tranexamic acid group demonstrated an improved but non-significant reduction in the units of blood transfused compared to placebo (P = 0.423). There was no clinically significant increase in complications in the tranexamic acid group, including no incidence of venous thromboembolism.     

The Efficacy Comparison of Tranexamic Acid for Reducing Blood Loss in Total Knee Arthroplasty at Different Dosage Time

Background

This study aimed to compare the efficacy of intravenous administration of tranexamic acid for reducing blood loss in total knee arthroplasty at different dosage time.

Efficacy and Safety of Postoperative Intravenous Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Study

ObjectiveTo assess the efficacy and safety of postoperative intravenous tranexamic acid (TXA) in patients undergoing total knee arthroplasty (TKA).MethodsFrom March 2020 to August 2020, all patients undergoing primary unilateral TKA in our hospital were considered in prospective randomized controlled study. Included patients were randomized into three groups to receive either two doses of 15 mg/kg intravenous TXA postoperatively, at 2 and 24 h after closing the incision (group A), or a single dose of 15 mg/kg intravenous TXA 2 h postoperatively (group B), or placebo (group C). The calculated total blood loss (TBL) and hidden blood loss (HBL), incidence of venous thromboembolism (VTE), and transfusion rate were compared among groups. The levels of prothrombotic state parameters including thrombomodulin (TM), thrombin‐anti‐thrombin complex (TAT), plasmin‐anti‐plasmin complex (PIC), and tissue‐type plasminogen activator‐plasminogen activator inhibitor complex (t‐PAI·C) in plasma were measured during the perioperative period. Patients were compared depending on the Kellgren‐Lawrence classification (K‐L types III and IV).ResultsAll patients were followed up for at least 4 weeks. The mean TBL and HBL in group C (1,182.45 ± 160.50; and 965.47 ± 139.61 mL, respectively) were significantly higher than those in groups A (944.34 ± 130.88 mL, P < 0.05; and 712.45 ± 129.82mL, P < 0.05, respectively) or B (995.20 ± 154.00 mL, P < 0.05; and 757.20 ± 134.39 mL, P < 0.05, respectively), but no significant differences were found between groups A and B (P > 0.05 and P > 0.05, respectively). None of the patients of three groups received blood transfusion, so there were no significant differences in blood transfusion rate among groups. Similar results were obtained with subgroups of patients who had the K‐L types III and IV. The DVT frequencies were four, three, and three in groups A, B, and C, respectively, with no significant differences after comparison (P > 0.05). There were no significant differences in the levels of prothrombotic state parameters (TM, TAT, PIC, t‐PAI·C) or incidence of VTE among groups (P > 0.05). Wound leakage was observed in five patients during the hospital stay (two patients in group A, one patient in group B, and two patients in group C), and no statistical difference was found in wound leakage or other complications among groups (P > 0.05).ConclusionsShort‐term application of postoperative intravenous TXA in TKAs resulted in reduced HBL without a measured increase in the actual incidence of VTE or the potential risk of thrombosis, but administration of TXA after the first 24 h had no significant effect.     

Efficacy of a Single Dose and an Additional Dose of Tranexamic Acid in Reduction of Blood Loss in Total Knee Arthroplasty

Background

This study aimed at evaluating the efficacy and safety of different regimens with a single dose and an additional postoperative dose of tranexamic acid (TA) in reducing blood loss in total knee arthroplasty (TKA).

Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates in Total Hip and Total Knee Arthroplasty

The objective of this study was to determine if tranexamic acid (TXA) applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). Two hundred and ninety consecutive patients from a single surgeon were enrolled. In TKA, TXA solution was injected into the knee after closure of the arthrotomy. In THA, the joint was bathed in TXA solution at three points during the procedure. In both THA and TKA the TXA solution was at a concentration of 3 g TXA per 100 mL saline. The mean blood loss was significantly higher in the non-TXA patients in both TKA and THA groups. Postoperative transfusions decreased dramatically with TXA, dropping from 10% to 0%, and from 15% to 1%, in the TKA and THA groups, respectively. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA.     

Evaluation of the Efficacy and Safety of Tranexamic Acid for Reducing Blood Loss in Bilateral Total Knee Arthroplasty

Tranexamic acid (TA) has been reported to reduce blood loss after total joint arthroplasty; however, the literature is sparse in evaluating its efficacy in simultaneous bilateral total knee arthroplasty (TKA). In this retrospective study of consecutive patients, TA use in bilateral TKA was associated with a significant reduction in perioperative serum hemoglobin drop, as well as allogeneic blood transfusion needs from 50% to 11% of patients. No autologous blood donation or drains were used. There were no venous thromboembolic events reported. Implementation of a systematic intravenous TA protocol in simultaneous bilateral TKA appears highly effective in reducing transfusion requirements, potentially reducing healthcare resource utilization as well as the morbidity and complications associated with allogeneic blood transfusions.     

Simultaneous Bilateral Computer Assisted Total Knee Arthroplasty: The Effect of Intravenous or Intraarticular Tranexamic Acid

The use of tranexamic acid (TA) in total knee arthroplasty is well documented. However, there is limited evidence to suggest the use of TA in simultaneous bilateral computer assisted total knee arthroplasty (CATKA). We, therefore, studied the effect of TA, in simultaneous bilateral computer assisted total knee arthroplasty, in terms of blood transfusion, routes of administration and complications. We divided 90 patients into three groups. Group I patients received intravenous normal saline alone (IVNS group). Group II received intravenous TA alone (IVTA group). Group III received intraarticular TA alone (IATA group). Our study confirms that there is significant benefit of using TA but no difference between the intravenous or intraarticular routes of administration.     

Tranexamic Acid to Reduce Blood Loss After Bilateral Total Knee Arthroplasty : A Prospective, Randomized Double Blind Study

The effects of 2-dosage regimens of tranexamic acid (10 mg/kg and 15 mg/kg) on blood loss and transfusion requirement were compared to saline placebo in 60 patients undergoing concurrent bilateral total knee arthroplasty, with additional reinfusion autotransfusion from intraarticular drains. Mean blood loss was 462 mL in 15 mL/kg group, 678 mL in 10 mg/kg group, and 918 mL in controls (P < .01 vs 15 mg/kg). Blood available for autotransfusion was greatest in controls and least in 15 mg/kg group. Combined autologous and allogenic transfusion volumes were similar in the treatment groups and significantly less than controls (P < .01). With use of an autologous reinfusion strategy, the lower dose is sufficient to lead to a lesser allogenic transfusion requirement.     

Tranexamic Acid for Reduction of Blood Loss During Total Hip Arthroplasty

In this study, we evaluated the hemostatic effects of tranexamic acid (TNA), an antifibrinolytic drug, by examining the timing of its administration during total hip arthroplasty. One hundred seven patients being treated for osteoarthritis of the hip joint were randomly divided into 5 groups based on the timing of TNA administration. The intraoperative blood loss, postoperative blood loss, and hemoglobin of these patients who received TNA at different times during the procedure were monitored. We found that the intraoperative blood loss in the preoperative TNA administration groups was significantly lower than both control and postoperative TNA administration groups. Furthermore, 1 g TNA 10 minutes before surgery and 6 hours after the first administration was most effective for the reduction of blood loss during total hip arthroplasty.     

Topical Application of Tranexamic Acid in Primary Total Hip Arthroplasty: A Randomized Double-Blind Controlled Trial

So far, studies of topical tranexamic acid (TXA) in total hip arthroplasty (THA) were still lacking and controversial. We conducted this randomized double-blind controlled trial which included 101 patients to assess the effect of a high-dose 3 g topical TXA in THA. The results showed that 3 g topical TXA could significantly reduce transfusions from 22.4% to 5.7% (P < 0.05) without increasing the risk of deep vein thrombosis (DVT), pulmonary embolism (PE) and other complications. In addition, topical TXA significantly reduced total blood loss, reduced drain blood loss, and the drops of HB and HCT in topical TXA group were lower than control group. We concluded that 3 g topical TXA was effective and safe in reducing bleeding and transfusions in THA.     

Comparison of 3 Routes of Administration of Tranexamic Acid on Primary Unilateral Total Knee Arthroplasty: A Prospective,Randomized, Controlled Study

Background

The mode of administration for tranexamic acid (TXA) to significantly reduce the decrease in hemoglobin (Hb), number of transfusions, relevant costs, and side effects in patients undergoing primary unilateral total knee arthroplasty (TKA) has not been resolved.

A Prospective Study on Role of Tranexamic Acid in Reducing Postoperative Blood Loss in Total Knee Arthroplasty and Its Effect on Coagulation Profile

Total knee arthroplasty(TKA) is associated with extensive postoperative blood loss. Despite various studies proving the efficacy of Tranexamic Acid (TEA) with single or multiple boluses of different sizes with or without subsequent infusions, no consensus has been reached on the dose of tranexamic acid to be administered or the duration of treatment. In this study, we have investigated in a homogenous healthy population undergoing total knee arthroplasty, if administration of a high dose of tranexamic acid has a blood sparing effect. They were found to be significant with high power concluding a decrease in total blood loss in patients who were administered Tranexamic Acid (TEA) during Total Knee Arthroplasty (TKA). A dose regimen of 15 mg/kg every 8 h for 24 h would seem appropriate as longer administration of TEA was not accompanied by further reduction in blood loss.