Impact of intravenous tranexamic acid on patients undergoing shoulder arthroplasty surgery

2020 ◽  
pp. 175857322097090
Author(s):  
E Kissin ◽  
K Al-Tawil ◽  
A Tavakkolizadeh ◽  
J Sinha ◽  
T Colegate-Stone
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Arthroplasty Surgery

Background Shoulder arthroplasty surgery carries the risk of blood loss. The antifibrinolytic tranexamic acid (TXA) is effective in reducing blood loss in lower limb arthroplasty. The purpose of this study was to assess blood loss and associated complications following shoulder arthroplasty performed with and without TXA for both elective and trauma indications. Methods A cohort study was performed to assess blood loss, transfusion requirements and post-operative venous thromboembolic events (VTE) following shoulder arthroplasty undertaken with and without the use of intravenous TXA. Results The study consisted of 67 patients ( n = 36 with TXA; n = 31 without TXA). Type of arthroplasty included reverse-shoulder arthroplasty, total-shoulder arthroplasty and hemiarthroplasty. There was no significant difference between TXA and non-TXA groups regarding blood loss (TXA group haemoglobin drop 20.6 mg/dL; non-TXA group haemoglobin drop 20.5 mg/dL; p = 0.978). There was no significant difference in measured outcomes with or without TXA use for elective or trauma indications, nor regarding type of arthroplasty. Discussion The use of intravenous TXA in shoulder arthroplasty was not associated with a significant reduction in blood loss or post-operative transfusion rates, nor did it impact on VTE. This result was not affected by the indication being elective or trauma nor the type of arthroplasty surgery performed.

scholarly journals Topical and Intravenous Tranexamic Acid Are Equivalent in Decreasing Blood Loss in Total Shoulder Arthroplasty

2019 ◽  
Vol 3 ◽  
pp. 247154921882118 ◽  
Author(s):  
Matthew Budge
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Control Group ◽  
Thromboembolic Events ◽  
Discharge Disposition ◽  
Significant Difference ◽  
Average Change ◽  
Tukey Honestly Significant Difference

Introduction Tranexamic acid (TXA) has been shown to be an effective modality to decrease blood loss in total shoulder arthroplasty (TSA). However, the most effective method of TXA administration remains controversial. The purpose of this study was to directly compare the use intravenous and topical TXA to determine which regimen was more effective in improving postoperative hemoglobin (Hb), transfusion rates, and patient outcomes after primary TSA. Methods We conducted a retrospective review of 3 sequential cohorts of patients undergoing primary TSA with no TXA, intravenous TXA, or topical TXA. Postoperative data collection included daily Hb levels (g/dL), transfusions, thromboembolic events, length of stay, and discharge disposition. One-way analysis of variance was used to compare data between the 3 groups with post hoc Tukey honestly significant difference test for differences between pairs. Results Average change in Hb was 2.36 g/dL in the IV TXA group and 2.27 g/dL in the Topical TXA group which was not statistically significant ( P = .69). Average change in Hb in the control group was 3.27 g/dL which was significant when compared to both TXA groups ( P < .01). There were no transfusions or thromboembolic events in either TXA group. In the control group, there were 2 transfusions which was not statistically significant ( P = .09). There was no significant difference in the discharge disposition or days in hospital between the 2 groups receiving TXA ( P = .33). Conclusion Intravenous and topical TXA are equivalent in improving postoperative Hb in TSA.

scholarly journals ε-Aminocaproic acid (EACA) vs. tranexamic acid (TXA) in children undergoing complex cranial vault reconstruction for repair of craniosynostosis

2021 ◽  
Author(s):  
Alexandra Borst ◽  
Christopher Bonfield ◽  
Poornachanda Deenadayalan ◽  
Chi Le ◽  
Meng Xu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Outcome Measures ◽  
Aminocaproic Acid ◽  
Cranial Vault ◽  
Secondary Outcome ◽  
Vascular Access Devices ◽  
Estimated Blood Loss ◽  
Transfusion Requirements ◽  
Significant Difference

INTRODUCTION: Children undergoing complex cranial vault reconstruction (CCVR) for craniosynostosis experience high rates of bleeding and transfusion, increasing risk for perioperative complications. ε-Aminocaproic acid (EACA) and tranexamic acid (TXA) are antifibrinolytic agents that have been shown to reduce intraoperative hemorrhage and transfusion requirements during CCVR. However, the relative efficacy of these two agents has not yet been evaluated. The aim of this study was to compare perioperative blood loss and transfusion rates in children receiving EACA vs. TXA. METHODS: All patients who underwent CCVR from September 2015 to December 2019 at a single center were retrospectively evaluated. Primary outcome measures included intraoperative estimated blood loss, postoperative drain output, transfusion volumes, and calculated blood loss. Secondary outcome measures included hematologic and coagulation parameters. RESULTS: 95 patients were included, with 47 patients in the EACA cohort and 48 patients in the TXA cohort. There were no significant differences in demographics, surgical outcomes, blood loss, transfusion requirement, or perioperative hematologic and coagulation laboratory values between the two cohorts. Adverse events were similar between the groups, but did include two seizure events and two thromboembolic events related to vascular access devices. DISCUSSION: We found no significant difference in blood loss, transfusion requirements, hematologic parameters, or outcomes between pediatric CCVR patients who received EACA vs. TXA. Further research is needed to define optimal antifibrinolytic dosing and duration of therapy. While standard laboratory parameters were similar between groups, future studies investigating coagulation-based and inflammatory assays may be useful in defining surgical-induced coagulopathy.

scholarly journals Prospective Comparative Study of Preoperative Expectations and Postoperative Outcomes in Anatomic and Reverse Shoulder Arthroplasty

Joints ◽  
2021 ◽  
Author(s):  
Cassandra Lawrence ◽  
Mark Lazarus ◽  
Joseph Abboud ◽  
Gerald Williams ◽  
Surena Namdari
Keyword(s):  
Shoulder Arthroplasty ◽  
Functional Outcomes ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Linear Regression Analysis ◽  
Postoperative Outcomes ◽  
Consecutive Series ◽  
Multivariate Linear Regression Analysis ◽  
Significant Difference ◽  
Preoperative Expectations

Abstract Background Compared with anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (RTSA) is associated with lower preoperative and postoperative outcome scores and range of motion. It is unknown whether patients' preoperative expectations of surgery are lower in RTSA compared with aTSA. The purpose of this study was to assess preoperative patient expectations and postoperative outcomes in aTSA and RTSA. Methods A consecutive series of patients undergoing primary aTSA for diagnosis of osteoarthritis or primary RTSA for diagnosis of rotator cuff tear arthropathy were studied prospectively. Expectations were evaluated using the validated Hospital for Special Surgery's Shoulder Surgery Expectations Survey. Baseline demographics, comorbidities, and social factors were collected. Baseline and 2 years postoperative American Shoulder and Elbow Surgeons (ASES) score, visual analog scale pain, Single Assessment Number Evaluation (SANE), and patient satisfaction were obtained. Results There were 128 patients (64 aTSA and 64 RTSA). There was no significant difference in total preoperative expectations score between groups. On multivariate linear regression analysis, aTSA (p = 0.024) and younger age (p = 0.018) were associated with higher expectations for improved ability to exercise. Changes in preoperative to postoperative ASES (p = 0.004) and SANE (p = 0.001) scores were higher in the aTSA group. Total preoperative expectations score was not correlated with postoperative functional outcomes or satisfaction in either group. In the aTSA group, expectations for participation in exercise were positively correlated with changes in preoperative to postoperative ASES score (p = 0.01) and SANE score (p = 0.01). Conclusion Though patients undergoing primary aTSA demonstrated greater improvement in functional outcome than those undergoing primary RTSA, both groups reported similar aggregate preoperative expectations. Those undergoing aTSA had higher expectations for return to exercise which was positively correlated with postoperative functional outcomes. Level of Evidence Level II, prospective cohort study.

A Randomized, Prospective Evaluation on the Effectiveness of Tranexamic Acid in Reducing Blood Loss after Total Shoulder Arthroplasty

2015 ◽  
Vol 24 (8) ◽  
pp. e234 ◽  
Author(s):  
Robert J. Gillespie ◽  
Yousef Shishani ◽  
Shane Hanzlik ◽  
Jonathan J. Streit ◽  
Reuben Gobezie
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Prospective Evaluation

441 Intravenous Tranexamic Acid Given at Femoral Fragility Fracture Surgery Reduces Blood Transfusion Requirements Four-Fold

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Powell-Bowns ◽  
R Olley ◽  
C McCann ◽  
J Balfour ◽  
C Brennan ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Fragility Fracture ◽  
Mean Difference ◽  
Complication Rates ◽  
Postoperative Blood Transfusion ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Fracture Surgery

Abstract Introduction Tranexamic acid (TXA) is proven to reduce blood loss in several surgical fields, but its use in femoral fragility fracture (FFF) management is ill defined. This study examined the effect of intraoperative TXA on the rate of postoperative blood transfusion following FFF. Method A prospective non-randomized case-control study of 361 consecutive patients admitted to the study centre with FFFs over a 4-month period was performed. Intravenous TXA 1g was administered intraoperatively at the discretion of the operating team: 178 patients received TXA and 183 did not. Results Patients given TXA required fewer blood transfusions: 15/178 (8.4%) vs controls 58/183 (31.7%), (p &lt; 0.001). Calculated blood loss (mean difference -222ml (-337 to -106, 95%CI), p &lt; 0.001) and percentage drop in Hb (mean difference -4.3% (-6.3 to -2.3, 95%CI), p &lt; 0.001) were significantly lower in the TXA group. The difference in CBL was greatest following intramedullary nail (n = 49: mean difference -394ml, p = 0.030) and DHS (n = 101, mean difference -216ml, p = 0.032). There was no significant difference in complication rates: venous thromboembolism TXA 2/178 vs control 1/182 (p = 0.620); MI/stroke/TIA 2/178 vs 0/182 (p = 0.244) Conclusions Intraoperative intravenous TXA significantly reduced calculated blood loss and blood transfusion requirements following femoral fragility fracture surgery without increasing the rate of complications.

scholarly journals The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Medicine ◽  
2017 ◽  
Vol 96 (37) ◽  
pp. e7880 ◽  
Author(s):  
Jing He ◽  
Xi-e Wang ◽  
Guo-Hong Yuan ◽  
Lian-Hai Zhang
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty
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