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Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty.

ABSTRACT: 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.

SUBMITTER: Konig G

PROVIDER: S-EPMC3807723 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty.

Konig Gerhardt G Hamlin Brian R BR Waters Jonathan H JH

The Journal of arthroplasty 20130723 9

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 ...[more]

PMID: 23886406

Similar Datasets

Use of Topical Tranexamic Acid Reduces Direct and Indirect Blood Loss and Transfusion Rates in Revision Total Hip Arthroplasty.

Project description:BackgroundIn primary total hip arthroplasty (THA), evidence supports the use of tranexamic acid (TXA) as an effective strategy for reducing blood loss, but scant evidence supports its use in revision THA.Questions/purposesWe aimed to evaluate whether the use of topical TXA in revision THA is associated with less blood loss and lower transfusion rates and to assess its safety, specifically as it relates to thromboembolic complications.MethodsIn this retrospective comparative study, two groups who underwent revision THA between 2005 and 2017 were defined: 98 patients who received 3 g of topical TXA (study group) and 475 patients who did not receive TXA (control group). Subjects were divided into subgroups according to the type of revision. Hemoglobin and hematocrit levels, blood loss, and transfusions were recorded. The follow-up period was 6 weeks.ResultsMedian estimated blood loss, hidden blood loss, hemoglobin drop, and transfusion rates were significantly lower in the study group. The rates of post-operative thromboembolism were similar in the two groups. According to subgroup analysis, patients with revision of the femoral component, both components, and staged exchange revisions showed significantly lower rates of transfusion.ConclusionTopical TXA administration during revision THA effectively reduced direct and indirect blood loss, including hidden losses, without increasing the rates of thromboembolic events. This effect appeared to be enhanced when the femoral component was revised.

| S-EPMC7749894 | biostudies-literature

Topical Tranexamic Acid Reduces Blood Loss in Minimally Invasive Total Knee Arthroplasty Receiving Rivaroxaban.

Project description:It is unclear whether topical (intra-articular) or intravenous TXA reduces blood loss in minimally invasive TKA patients receiving a direct oral anticoagulant for thromboprophylaxis. This study is to investigate whether TXA given intravenously or intra-articularly is effective in reducing blood loss in minimally invasive TKA patients using rivaroxaban for thromboprophylaxis.Ninety-three patients who underwent primary minimally invasive TKA were divided into placebo group (30 patients) that received saline both intravenously and intra-articularly, intravenous (IV) group (31 patients) that received 1?g TXA intravenously, and topical group (32 patients) that received 3?g TXA in 100?ml saline intra-articularly. All patients received oral rivaroxaban of 10?mg daily for 14 days postoperatively.p < 0.001 and p = 0.041. The mean total blood loss was 1131?mL (567-1845) in placebo, which was higher than that in the IV group (921?mL; range, 465-1495; p = 0.014) and the topical group (795?mL; range, 336-1350; p < 0.001). The total blood loss did not differ between the IV and the topical group (p = 0.179).This prospective, randomized, controlled trial demonstrated an equal efficacy of TXA in blood conservation when administered intravenously or topically in minimally invasive TKA patients receiving rivaroxaban for thromboprophylaxis.

| S-EPMC5749315 | biostudies-literature

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

Project description: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 (20 mg/kg in 100 mL of saline; group IV), topically (1.5 g in 50 mL of saline, sprayed over the operated site, before release of the tourniquet; topical group), or intravenous saline (100 mL with anesthesia; control group). The volume of drained blood in 48 h, 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 3.8 mg/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.

| S-EPMC5643894 | biostudies-literature

Transfusion Avoidance in Severely Anemic Total Hip and Total Knee Arthroplasty Patients: An Analysis of Risk.

Project description:BackgroundAllogenic blood transfusions increase the risk of multiple complications. We evaluated the influence of restricting transfusions in adults with osteoarthritis that underwent total hip or knee arthroplasty (THA/TKA) with severe postoperative anemia.Material and methodsPatients that underwent THA/TKA for osteoarthritis with postoperative hemoglobin (Hb) ≤ 8 g/dl were retrospectively identified. We evaluated characteristics and adverse postoperative outcomes of patients not transfused and compared them to those of patients who received postoperative transfusion. Adverse outcomes were 90-day readmission, reoperation, infection, and falls, as well as inpatient cardiovascular events and deaths.ResultsOne thousand eighty-seven patients meeting inclusion criteria underwent THA and TKA. The 399 patients (36.7%) who did not undergo transfuion were younger (67.4 vs 69.5 years, P = .008), healthier (American Society of Anesthesiologist ≤ 2: 64.2% vs 56%, P = .006), comprised a lower proportion of cardiovascular disease patients (13.8% vs 24.7%, P < .001), a lower proportion of patients with Medicare/Medicare Managed Care (57.2% vs 65.5%, P = .05), received tranexamic acid more frequently (66.4% vs 52.9%, P < .01), had a shorter procedure time (92.7 vs 103.1, P < .01), a lower postoperative drop in Hb (4.0 vs 4.2 g/dl, P = .022), a later drop in Hb (2.6 vs 2.2 days, P = .003), and a shorter length of stay (3.5 vs 4.8, P < .01). TKA patients underwent transfusion more frequently than THA patients (67.5% vs 59%, P = .004). There were no postoperative deaths. Adverse events were similar between the 2 groups.ConclusionFindings suggest that younger and healthier patients that have lower Hb later during their hospital stay need not undergo transfusion solely based on Hb levels. Routine transfusion triggers can be avoided even in more anemic patients.

| S-EPMC8924318 | biostudies-literature

Is topical or intravenous tranexamic acid preferred in total hip arthroplasty? A randomized, controlled, noninferiority clinical trial.

Project description:PURPOSE:The present study aimed to confirm the efficacy and safety of topical and intravenous tranexamic acid (TXA) compared with that of topical placebo and to assess the noninferiority between the two application methods of TXA in patients undergoing unilateral primary total hip arthroplasty. METHODS:Our randomized controlled trial investigated 170 patients with 1:1:1 allocation to two doses of 10-mg/kg intravenous TXA, 3-g topical TXA, and topical placebo of 60-ml physiological saline groups. The primary outcome, total blood loss, was calculated with Nadler and Gross formula. The secondary outcomes included allogeneic blood transfusion requirement, drain blood loss, decreased hemoglobin level. Noninferiority would be established when the upper limit 95% CI is lower than 250 ml of the noninferiority margin for the mean difference of total blood loss between topical and intravenous TXA. Thromboembolic complication incidence was considered as a safety outcome. RESULTS:The total blood loss of patients administered intravenous (mean±standard deviation, 1125±514 ml) and topical TXA (1211±425 ml) was significantly reduced compared with that of those administered topical placebo (1464±556 ml) (p = 0.0012). Drain blood loss and hemoglobin level reduction in patients administered with TXA were also significantly lower than those in patients administered topical placebo. The mean difference of total blood loss between topical and intravenous TXA is 86 ml (95% CI, -88 to 260 ml). The complications were comparable between patients managed with TXA and patients with topical placebo. CONCLUSION:The noninferiority of topical TXA to intravenous TXA can not be concluded. Considering no significant difference was found in all efficacy outcomes between the two administration methods. Any of the two TXA administration methods can be adopted for blood loss prevention in total hip arthroplasty.

| S-EPMC6168126 | biostudies-literature

The Efficacy and Safety of Tranexamic Acid in Total Hip and Knee Arthroplasty: A Literature Review

Project description: Not available

| S-EPMC10863588 | biostudies-literature

Surgical site infection and transfusion rates are higher in underweight total knee arthroplasty patients.

Project description:BackgroundUnderweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion.MethodsA case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] < 18.5 kg/m2) from 2000-2012 and were matched for age, gender, date of surgery, age-adjusted Charlson comorbidity index, rheumatoid arthritis, and diabetes. These patients were compared to 81 normal weight patients (BMI 18.5-24 kg/m2). Demographic variables were compared, along with wound complications, surgical site infection (SSI), blistering, deep vein thrombosis, pulmonary embolism, transfusion, revision, flexion contracture, hematoma formation, and patellar clunk.ResultsThe average BMI was 17.1 kg/m2 (range 12.8-18.4) for UW and 23.0 kg/m2 (range 19.0-25.0) for normal weight patients (P < .001). UW TKA patients were more likely to develop SSIs (3/27, 11.1% vs 0/81, 0.0%, P = .01) and were more likely to require transfusions (odds ratio = 3.4, confidence interval 1.3-9.1; P = .02).ConclusionsOur study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The specific reasons are unclear, but we conjecture that it may be related to decreased wound healing capabilities and low preoperative hemoglobin. Investigation of local tissue coverage and hematologic status may be beneficial in this patient population to prevent SSI. Based on the results of this study, a prospective evaluation of these factors should be undertaken.

| S-EPMC5365405 | biostudies-literature

Post-operative hypertension after total knee arthroplasty and the effects on transfusion rates.

Project description:Transfusions are a cause of significant patient morbidity as well as expense. Anesthesia literature has examined controlled intraoperative hypotension as a means for reducing blood loss and transfusions. Our hypothesis is that inversely increased blood pressure post-operatively would then lead to increased blood loss and transfusions.We examined 105 consecutive patients who underwent TKA. We found a significant odds ratio of 1.123 for pre-operative hematocrit. For post-operative blood pressure, we calculated an insignificant odds ratio of 1.007, proving no relationship between post-operative blood pressure and transfusions.This is the first study to examine increased post-operative blood pressure's contribution to transfusion rates. Although we confirmed that low pre-operative hematocrit contributes to increased transfusions, we did not find a relationship between post-operative blood pressure and transfusions.

| S-EPMC3530586 | biostudies-other

Tourniquet and tranexamic acid use in total knee arthroplasty.

Project description:BackgroundThere is no consensus on how tourniquet and tranexamic acid (TXA) use in total knee arthroplasty (TKA) affect blood transfusion rates and total blood loss. We compared outcome measures and transfusion rates after TKA, with and without the use of tourniquet and TXA.MethodsA retrospective study of 477 consecutive patients undergoing primary TKA between 2008 and 2013 was performed. There were 243 in the tourniquet-assisted (TA) and 234 in the tourniquet-unassisted (TU) group. Operative times, hemoglobin levels, blood transfusion rates, complications, and length of stay were assessed. Subanalysis was performed on those patients receiving and not receiving TXA within the TU group.ResultsMean operative duration was 66.4 minutes in the TA group and 87.5 minutes in the TU group (P < .0001). Mean postoperative drop in hemoglobin was greater in TU group (3.1 g/dL vs 2.8 g/dL, P = .002). The transfusion rate was 9.5% in TA compared with 11.5% in TU patients (P = .46) with comparable mean units transfused (2.6 vs 2.2, P = .30). There was no difference in wound infection (P = .82) and total complication rates (P = .27) between groups. Those patients given TXA had a lower hemoglobin drop (2.6 g/dL vs 3.3 g/dL, P = .04) with similar transfusion (13.3% vs 11%, P = .61) and complication (P = .95) rates.ConclusionsTU TKA had a greater operative duration and postoperative drop in hemoglobin than TA TKA. However, transfusion rates were similar between groups. TXA use reduced the operative decrease in hemoglobin with no effect on complication or transfusion rates.Level of evidenceLevel III, retrospective cohort study.

| S-EPMC7303488 | biostudies-literature

Disagreement in Readmission Rates After Total Hip and Knee Arthroplasty Across Data Sets.

Project description:BackgroundIn 2014, the Affordable Care Act Hospital Readmissions Reduction Program began penalizing hospitals for excessive readmission rates 30 days after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Various data sets with nonstandardized validation processes report readmission data, which may provide conflicting outcome values for the same patient populations.MethodsWe queried 4 separate data sets: the American Joint Replacement Registry, Centers for Medicare and Medicaid Services billing data, the Vizient data set, and an advanced analytics integration (Cognos) report from our electronic medical record. We identified 2763 patients who underwent primary TKA and THA at a single academic medical center from June 2016 to June 2019. We then matched 613 surgery encounters in all 4 databases. Our primary outcome metric was 30-day readmissions. Fleiss' Kappa was used to measure agreement among the different data sets.ResultsOf the 613 THA and TKA patients, there were 45 (7.3%) readmissions noted. Data collected from the Centers for Medicare and Medicaid Services flagged 41 (6.7%) readmissions, Vizient flagged 11 (1.8%) readmissions, and the American Joint Replacement Registry and Cognos report both flagged 6 (0.98%) readmissions each. None of the readmissions were identified by all 4 data sets. There was significant disagreement among data sets using Fleiss' Kappa (kappa = -0.1318, P = .03).ConclusionThere is disagreement in readmission rates in databases receiving the same patient data after THA and TKA. Care must be taken to establish standard validation processes and reporting methods and scrutiny applied when interpreting readmission rates from various data sets.

| S-EPMC8141417 | biostudies-literature

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