Effect of Multiple Doses of Oral Tranexamic Acid on Haemostasis and Inflammatory Reaction in Total Hip Arthroplasty: A Randomized Controlled Trial

2018 ◽  
Vol 119 (01) ◽  
pp. 092-103 ◽  
Author(s):  
Duan Wang ◽  
Yang Yang ◽  
Chuan He ◽  
Ze-Yu Luo ◽  
Fu-Xing Pei ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Inflammatory Response ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Multiple Dose ◽  
Control Group ◽  
Total Hip ◽  
Estimated Blood Loss ◽  
Significant Difference

AbstractTranexamic acid (TXA) reduces surgical blood loss and alleviates inflammatory response in total hip arthroplasty. However, studies have not identified an optimal regimen. The objective of this study was to identify the most effective regimen of multiple-dose oral TXA in achieving maximum reduction of blood loss and inflammatory response based on pharmacokinetic recommendations. We prospectively studied four multiple-dose regimens (60 patients each) with control group (group A: matching placebo). The four multiple-dose regimens included: 2-g oral TXA 2 hours pre-operatively followed by 1-g oral TXA 3 hours post-operatively (group B), 2-g oral TXA followed by 1-g oral TXA 3 and 7 hours post-operatively (group C), 2-g oral TXA followed by 1-g oral TXA 3, 7 and 11 hours post-operatively (group D) and 2-g oral TXA followed by 1-g oral TXA 3, 7, 11 and 15 hours post-operatively (group E). The primary endpoint was estimated blood loss on post-operative day (POD) 3. Secondary endpoints were thromboelastographic parameters, inflammatory components, function recovery and adverse events. Groups D and E had significantly less blood loss on POD 3, with no significant difference between the two groups. Group E had the most prolonged haemostatic effect, and all thromboelastographic parameters remained within normal ranges. Group E had the lowest levels of inflammatory cytokines and the greatest range of motion. No thromboembolic complications were observed. The post-operative four-dose regimen brings about maximum efficacy in reducing blood loss, alleviating inflammatory response and improving analgaesia and immediate recovery.

Two Doses of Intravenous Tranexamic Acid Offers No Benefit over One Dose in Total Hip Arthroplasty

2019 ◽  
Vol 04 (01) ◽  
pp. 001-006
Author(s):  
Ryan S. Charette ◽  
Jenna A. Bernstein ◽  
Matthew Sloan ◽  
Corbyn M. Nchako ◽  
Atul F. Kamath ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Univariate Analysis ◽  
High Volume ◽  
Primary Outcome Measure ◽  
Transfusion Rate ◽  
Total Hip ◽  
Significant Difference

AbstractTranexamic acid (TXA) has been shown to reduce blood loss and transfusions in total hip arthroplasty (THA). There is no consensus on the ideal number of doses that best reduces blood loss while limiting complications. Our study compared one versus two doses of intravenous TXA in primary THA and its effect on blood transfusion rate. We retrospectively reviewed patients undergoing primary THA at our two high-volume arthroplasty centers from 2013 to 2016. Patients were included if they underwent unilateral primary THA, and received one or two doses of TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome measure was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay (LOS), rate of deep vein thrombosis/pulmonary embolism (DVT/PE), readmission, and reoperation. A total of 1,273 patients were included; 843 patients received one dose of TXA and 430 patients received two TXA doses. Univariate analysis demonstrated no significant difference in transfusion rate when administering one versus two doses. There was no significant difference in LOS, or rates of DVT/PE, readmission, and reoperation. When comparing patients receiving aspirin prophylaxis, there was a significantly decreased blood volume loss with two doses (1,360 vs. 1,266 mL, mean difference = 94 mL; p = 0.017). In patients, undergoing primary unilateral THA, there is no difference in postoperative transfusion rate with one or two doses of intravenous TXA. There was no difference in thromboembolic events. Given the added cost without clear benefit, these findings support one rather than two doses of TXA during primary THA.

scholarly journals Effect of carbazochrome sodium sulfonate combined with tranexamic acid on blood loss and inflammatory response in patients undergoing total hip arthroplasty

2021 ◽  
Vol 10 (6) ◽  
pp. 354-362
Author(s):  
Yue Luo ◽  
Xin Zhao ◽  
Zhouyuan Yang ◽  
Releken Yeersheng ◽  
Pengde Kang
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Inflammatory Response ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Transfusion Rate ◽  
Sodium Sulfonate ◽  
Total Hip ◽  
Perioperative Blood Loss ◽  
Group D

Aims The purpose of this study was to examine the efficacy and safety of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) on blood loss and inflammatory responses after primary total hip arthroplasty (THA), and to investigate the influence of different administration methods of CSS on perioperative blood loss during THA. Methods This study is a randomized controlled trial involving 200 patients undergoing primary unilateral THA. A total of 200 patients treated with intravenous TXA were randomly assigned to group A (combined intravenous and topical CSS), group B (topical CSS), group C (intravenous CSS), or group D (placebo). Results Mean total blood loss (TBL) in groups A (605.0 ml (SD 235.9)), B (790.9 ml (SD 280.7)), and C (844.8 ml (SD 248.1)) were lower than in group D (1,064.9 ml (SD 318.3), p < 0.001). We also found that compared with group D, biomarker level of inflammation, transfusion rate, pain score, and hip range of motion at discharge in groups A, B, and C were significantly improved. There were no differences among the four groups in terms of intraoperative blood loss (IBL), intramuscular venous thrombosis (IMVT), and length of hospital stay (LOS). Conclusion The combined application of CSS and TXA is more effective than TXA alone in reducing perioperative blood loss and transfusion rates, inflammatory response, and postoperative hip pain, results in better early hip flexion following THA, and did not increase the associated venous thromboembolism (VTE) events. Intravenous combined with topical injection of CSS was superior to intravenous or topical injection of CSS alone in reducing perioperative blood loss. Cite this article: Bone Joint Res 2021;10(6):354–362.

scholarly journals Intravenous versus Intra-Articular Tranexamic Acid in Primary Total Hip Arthroplasty: A Prospective Randomised Double Blinded Non-Inferiority Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Afsana Hasan ◽  
David Campbell ◽  
Peter Lewis
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Mode Of Delivery ◽  
Secondary Outcome ◽  
Total Hip ◽  
Significant Difference ◽  
Double Blinded ◽  
Primary Total Hip Arthroplasty

Introduction Tranexamic acid (TXA) has been shown to be effective in reducing post-operative blood loss after hip replacement surgery. Clinicians can be reluctant to administer intravenous (IV) TXA to high risk patients and intra-articular (IA) administration has been proposed as an alternative mode of delivery. This study was conducted to compare the efficacy of IV versus IA administration of TXA.   Methods This prospective, double blinded, randomised non-inferiority trial, compared 69 patients undergoing primary total hip arthroplasty (THA) who received either 3 doses of 15mg/kg of IV TXA or 3 g of IA TXA after capsular closure. The primary outcomes were change in Hb and the rate of blood transfusion. The secondary outcome was the rate of VTE.   Results The mean haemoglobin level change from pre-operative to day 1 post-operative for the IV group was 26.7g/L and for IA group was 27.3g/L. No statistically significant difference was detected between the two groups (p=0.82). No patients required a transfusion or developed a VTE.   Conclusions IA administration of TXA can be equally effective as IV in the reduction of blood loss and the prevention of post-operative anaemia in primary THA.

scholarly journals Efficacy of continuous local cryotherapy following total hip arthroplasty

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 13
Author(s):  
Kentaro Iwakiri ◽  
Akio Kobayashi ◽  
Yuichi Takeuchi ◽  
Yusuke Kimura ◽  
Yoichi Ohta ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Diclofenac Sodium ◽  
Adverse Outcomes ◽  
Control Group ◽  
Thigh Circumference ◽  
Total Hip ◽  
Estimated Blood Loss

Background: Cryotherapy is rarely reported on the usefulness of cryotherapy applied after total hip arthroplasty (THA), and there are no reports about patient satisfaction against the cryotherapy following THA. The aim of this study was whether cryotherapy can be useful for relieving pain, reducing blood loss, and swelling, and improving patient satisfaction after THA. Methods: Thirty patients who had undergone THA were treated by a controlled cooling device for 72 h following THA (defined as the cryotherapy group). The other 30 patients without cryotherapy were not treated with cryotherapy (defined as the control group). Blood samples (creatine kinase, and C-reactive protein), estimated blood loss, visual analog scale (VAS) of pain score, total doses of diclofenac sodium suppository used for pain relief, thigh swelling, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and adverse outcomes were compared between two groups. Results: Thigh circumference, measured on only day 4 postoperatively, was significantly lower in the cryotherapy than in the control group. Furthermore, patient satisfaction on postoperative days 4 and 7 was significantly higher in the cryotherapy than in the control group. There were no significant differences in other outcomes between groups. Conclusions: These results support the potential benefit of cryotherapy for the reduction of swelling, and patient satisfaction during postoperative recovery of patients undergoing THA, even in the presence of periarticular injection and tranexamic acid administration for the prevention of postoperative pain and bleeding. Postoperative cryotherapy is a potentially simple, noninvasive, and relatively inexpensive option for post-THA management.

scholarly journals Intravenous administration of tranexamic acid in total hip arthroplasty does not change the blood coagulopathy: a prospective thrombelastography analysis

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095951
Author(s):  
Xing-chen Zhang ◽  
Ma-ji Sun ◽  
Sheng Pan ◽  
Min Rui ◽  
Feng-chao Zhao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Laboratory Tests ◽  
Degradation Products ◽  
Total Blood Loss ◽  
Control Group ◽  
Total Blood ◽  
Total Hip

Objective: Despite the wide use of tranexamic acid (TXA) in the perioperative period of total hip arthroplasty (THA), whether the hemostatic state changes after the application of intravenous (IV)-TXA are still unknown. The aim of this study was to investigate whether IV administration of TXA changes the blood coagulation following primary THA via thrombelastography (TEG) analysis and conventional laboratory tests. Methods: A total of 174 patients who underwent primary THA from September 2016 to July 2018 were selected. They were randomly divided into two groups, 86 patients with IV administration of 15 mg/kg TXA and 88 controls without TXA usage. Demographic data, TEG paremeters, d-dimer levels, fibrin degradation products, hemoglobin, hematocrit concentration, platelet, transfusion rates, perioperative blood loss, and the occurrence of deep vein thrombosis were collected. TEG and conventional laboratory tests were performed the day before operation, the first day after operation, and seventh day after operation. Results: There were no differences with regard to TEG or conventional laboratory tests between the two groups ( p > 0.05). The total blood loss and drain blood loss in the TXA group were significantly lower than those in the control group ( p < 0.05). The transfusion rates and the volume of blood transfusion of the control group were higher than those of the TXA group ( p < 0.05). Conclusion: The administration of IV-TXA resulted in a significant reduction in total blood loss, transfusion volumes, and transfusion rates without the increase of thromboembolic complications. Moreover, it was confirmed that TXA would not change the coagulation via the TEG analysis.

scholarly journals Less Blood Loss With Tranexamic Acid in Primary Total Hip Arthroplasty Using the Direct Anterior Approach: a One-center Retrospective Observational Study

2021 ◽  
Author(s):  
Xian-Ren Zhu ◽  
Lei Wang ◽  
Hong-Wei Li ◽  
Guo-Chun Zha
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Control Group ◽  
Transfusion Rate ◽  
Total Hip

Abstract Background: It is still not known whether tranexamic acid is beneficial for the minimally invasive surgical approach to total hip arthroplasty (THA). This study seeks to investigate the efficacy and safety of intravenous tranexamic acid (TXA) in primary THA via the direct anterior approach (DAA). Methods: We performed a retrospective analysis of prospectively collected data on 70 patients with non-traumatic avascular necrosis of the femoral head who underwent total hip arthroplasty (THA) via the DAA between October 2017 and October 2018. Patients were divided into two groups: TXA group (39 patients who did receive 1.5g TXA intravenously) and control group (31 patients who did not receive TXA). Patients were assessed by the operative time, postoperative hemoglobin (HB) drop, transfusion rate, postoperative length of hospital stays (LHS), deep vein thrombosis (DVT), and Harris hip score (HHS).Results: The total blood loss, hidden blood loss, and postoperative HB drop in the TXA group were significantly lower than those in the control group (p < 0.05). There was no statistical difference in terms of intraoperative blood loss, operation time, transfusion rate, postoperative LHS, HHS, and the incidence of DVT between the two groups (p > 0.05). Conclusion: TXA may be reduce perioperative blood loss and not increase complications, in THA via the DAA.

scholarly journals Effects of Tranexamic Acid on Blood Loss during Total Hip Arthroplasty

2010 ◽  
Vol 18 (3) ◽  
pp. 282-286 ◽  
Author(s):  
Jagwant Singh ◽  
Moez S Ballal ◽  
P Mitchell ◽  
PG Denn
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Total Hip
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