Tranexamic Acid in Foot and Ankle Surgery: A Topical Review and Value Analysis

2021 ◽  
pp. 193864002098363
Author(s):  
William L. Johns ◽  
Kempland C. Walley ◽  
Benjamin Jackson ◽  
Tyler A. Gonzalez
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Potential Role ◽  
Wound Complications ◽  
Foot And Ankle ◽  
Value Analysis ◽  
Increased Risk ◽  
Ankle Surgery ◽  
Minimize Blood Loss ◽  
Potential Benefits

Tranexamic acid (TXA) has become a commonly used perioperative intervention in total joint arthroplasty, shoulder and knee arthroscopy, and spinal procedures in order to minimize blood loss, hematoma formation, hemarthrosis, and wound healing complications. There is a potential role for TXA use in foot and ankle procedures, with limited studies suggesting a potential benefit in minimizing postoperative wound complications and blood loss without an increased risk of thromboembolic events. In light of the profound clinical and financial impact of TXA use in other orthopaedic subspecialties and the early successes in foot and ankle surgery, we aim to provide more information about TXA and its use in foot and ankle surgery. Therefore, the purpose of this review is to perform a comprehensive literature review on the topic of TXA use in foot and ankle procedures in order to describe the pertinent available literature on the use of TXA in orthopaedic surgery and its implications specifically in foot and ankle surgery. It is our aim to identify potential benefits and shortcomings in the available evidence on TXA use for foot and ankle surgery in hopes to (1) best inform foot and ankle surgeons where beneficial and safe and (2) inspire further research on this topic as it relates to clinical management for foot and ankle patients. Levels of Evidence: Level IV

scholarly journals Tranexamic Acid Use in Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142097541
Author(s):  
William L. Johns ◽  
Kempland C. Walley ◽  
Raees Seedat ◽  
Benjamin Jackson ◽  
Karim Boukhemis ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Care Setting ◽  
Urgent Care ◽  
Wound Complications ◽  
Day Hospital ◽  
Foot And Ankle ◽  
Hematoma Formation ◽  
Ankle Surgery ◽  
Return Visits ◽  
Urgent Care Setting

Background: There is a potential role for tranexamic acid (TXA) use in foot and ankle procedures; however, the benefits of this intervention have not been fully elucidated. The purpose of this study was to explore the safety, outcomes, and medical complication profile of the use of intravenous TXA in patients undergoing foot and ankle surgery. Methods: A prospective study with retrospective review of 241 patients undergoing elective and traumatic foot and ankle procedures was performed. One gram of intravenous (IV) TXA was administered prior to incision. Patients were followed and evaluated for medical comorbidities, intraoperative blood loss, wound complication, superficial and deep infections, hematoma formation, medical complications, 30-day hospital readmission rate, and return visits to the emergency department or urgent care setting prior to first postoperative visit. Descriptive statistics were used for subgroup analysis. Mean postoperative follow-up was 4.5 months. Results: Estimated blood loss in all cases was less than 20 mL. There was 1 case of superficial cellulitis (1/241, 0.4%), 1 deep infection after Achilles tendon repair (1/241, 0.4%), 4 cases of delayed wound healing (4/241, 1.6%), 1 instance of deep vein thrombosis (1/241, 0.4%), and 2 cases of postoperative pulmonary embolism (2/241, 0.8%). There were no instances of postoperative hematoma formation. There were no additional recorded thromboembolic events. There were no adverse drug reactions. There were no 30-day hospital readmissions or return visits to the emergency department or urgent care setting before the first postoperative visit. In a subgroup analysis, there was no significant difference in wound complications or infections between nondiabetics and diabetics ( P > .05) and traumatic and nontraumatic cases ( P > .05). Conclusions: The use of IV TXA in foot and ankle surgeries was associated with low risk of wound complications, infections, hematoma formation, thromboembolic events, and overall complication rates with minimal side effect profile. Perioperative tranexamic acid use may prove to be beneficial in foot and ankle surgery patients but especially in higher-risk patients such as those with diabetes, trauma, and those that are immunocompromised. Level of Evidence: Level IV, case series.

scholarly journals Subsequent Injury is Common after Foot and Ankle Surgery in Patients Receiving Workers’ Compensation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017
Author(s):  
Gabrielle Bui ◽  
Phinit Phisitkul ◽  
Natalie Glass ◽  
Chris Cychosz ◽  
Sean Boarini
Keyword(s):  
Retrospective Chart Review ◽  
Anatomical Location ◽  
Workers Compensation ◽  
Foot And Ankle ◽  
Chi Square ◽  
Legal Representation ◽  
Increased Risk ◽  
Ankle Surgery ◽  
Poor Outcomes ◽  
Subsequent Injury

Category: Ankle Introduction/Purpose: Workers’ compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries. Previous studies have investigated surgical outcomes via satisfaction surveys, but rates of subsequent injury following surgery have not been specifically studied. The purpose of this study was to investigate the rates, locations and risk factors for subsequent injuries in WC patients and non-WC patients who underwent the same surgeries. Methods: With IRB approval, we identified the records of patients with a foot or ankle surgery performed by a single surgeon from 2009-2015. We included only surgeries with one of the most common current procedural terminology (CPT) codes from the WC population. A retrospective chart review was performed on all WC and non-WC patients with at least one of these CPT codes. A subsequent injury was defined as a new injury at a different anatomical location that occurred from 2 months to 2 years after the index surgery. Chi-square and two-tailed t-tests were used to compare WC and non-WC patient populations, and to determine factors associated with subsequent injuries. Results: Overall, the WC population had higher rates of subsequent injury than the non-WC population 23.21% versus 7.27%, p=.0011. Within the WC patient population, patients with subsequent injuries were older than patients without subsequent injuries 48.78±7.30 versus 41.58±12.40, p=.0137. In a blinded review of the charts and Iowa Courts Online, legal representation was found to be more common in WC patients with subsequent injuries than WC patients without subsequent injuries (76.92% versus 37.21%, p=.0240). In the non-WC population, there were more males in the group without subsequent injuries than in the group with subsequent injuries 42.48% versus 8.33%, p=.0287. There were no significant differences in locations of subsequent injury. Hip, knee and contralateral foot and ankle were common areas of subsequent injury in both groups. Conclusion: Overall, WC patients had higher rates of subsequent injury than non-WC patients. Within the WC group, legal representation further raised the risk of subsequent injury. Gender may mediate variable reporting of subsequent injuries in non-WC populations. While the reason for this increased risk of subsequent injury is not known, the differences are enough that they should be considered when counseling WC patients considering these surgeries. Additionally, if further study supported these findings, knowledge of the areas at risk for subsequent injury might lead to preventative strategies that could decrease the risk of subsequent injury.

scholarly journals Incidence of Venous Thromboembolism in Orthopaedic Foot and Ankle Surgeries

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Ashish Shah ◽  
Samuel Huntley ◽  
Harshadkumar Patel ◽  
Eildar Abyar ◽  
Eva Lehtonen ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Improvement Program ◽  
Female Sex ◽  
Increased Risk ◽  
Ankle Surgery

Category: Other Introduction/Purpose: Venous thromboembolism (VTE) is a rare but potentially lethal complication following orthopaedic foot and ankle surgery. Surgeons continue to debate the types of patients and procedures in which it is appropriate to use chemical thromboprophylaxis. A recent meta-analysis concluded that patients at high risk for VTE after foot and ankle surgery should receive prophylaxis, but there remains a paucity of data to elucidate which demographic or comorbidity variables are most strongly associated with development of VTE. The incidence of VTE after orthopaedic foot and ankle surgery stratified by specific procedure has yet to be examined. The purpose of this study is to report the incidence of and identify risk factors for VTE in a large sample of patients receiving orthopaedic foot and ankle surgery. Methods: In this study, we retrospectively analyzed prospectively-collected data from the National Surgical Quality Improvement Program (NSQIP) 2006 to 2015 data files. The incidence of VTE was calculated for 30 specific orthopaedic foot and ankle surgeries and for four broad types of foot and ankle surgery. A total of 23,212 patients were identified and grouped by current procedures terminology (CPT) codes. Demographic, comorbidity, and complication variables were analyzed to determine associations with development of VTE. Pearson’s chi-squared test was used to compare categorical variables and Student t test was used to compare continuous variables. P-values of p<0.05 were considered statistically significant. Multivariable modelling was not possible due to the very low number of VTE cases relative to non-VTE cases. Results: The mean age at the time of surgery was 52.7±17.8 years. VTE events were documented 142 times in our sample, yielding an overall sample VTE incidence of 0.6%. The types of procedures with the highest frequency of VTE were ankle fractures (105/15,302 cases, 0.7%), foot pathologies (28/5,466, 0.6%), and arthroscopy (2/398, 0.5%). Female sex, increasing age, obesity level, inpatient status, and non-elective surgery were all significantly associated with VTE events. Postoperative pneumonia was significantly associated with VTE development. Patients who developed a VTE stayed at the hospital after surgery significantly longer than patients without VTE (6.2 vs. 3.1 days). Patients who developed VTE also had significantly higher estimated probability of morbidity (8.0% vs. 6.0%) and mortality (2.0% vs. 1.0%) when compared to patients without VTE. Conclusion: The present study confirms that VTE events after foot and ankle procedures are rare. The data presented suggest that female sex, increasing age, higher BMI, inpatient status, and non-elective procedures are associated with increased risk for VTE after orthopaedic foot and ankle surgery. Prospective, randomized, controlled trials are necessary to definitively determine the efficacy of chemoprophylaxis and to develop evidence-based clinical practice guidelines to minimize VTE after foot and ankle procedures.

scholarly journals The Use of Tranexamic Acid in Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Laura Luick ◽  
Vytas Ringus ◽  
Garrett Steinmetz ◽  
Spencer Falcon ◽  
Shaun Tkach ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
P Value ◽  
Ankle Arthroplasty ◽  
Estimated Blood Loss ◽  
Number Of Patients ◽  
Significant Difference

Category: Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) is on the rise. Complications associated with TAA include need for blood transfusion, deep vein thrombosis, hematoma, infection, and wound complications. Tranexamic acid (TXA) use in the total knee and total hip population has been found to decrease the rate of blood transfusion. The rate of infections and blood transfusions in TAA was reported to be 3.2% and 1.3%, respectively. In calcaneal fractures TXA was found to decrease wound complications. Our goal was to evaluate the use of TXA in the TAA population to see if its use decreases blood loss or wound complications. Methods: This is a retrospective review of two patient cohorts operated on by a single surgeon from 2010 to 2016. We compared a group of TAA patients that did not receive TXA versus a subsequent group that received TXA. Patients received 1 g IV TXA before tourniquet was inflated and another 1 g following the release of the tourniquet. Pre-operative hemoglobin and hematocrit levels were compared to postoperative levels. Post-operative complications were compared between the two groups. Results: 87 patients were included in the study. 35 patients (40%) received TXA. In patients that received TXA, 18 had postoperative hemoglobin levels available. These patients were compared to a control cohort of 52 patients that did not receive TXA. No significant difference existed between the two groups in gender or age (p=0.9; p=0.7 respectively). Mean estimated blood loss was the same between the two groups. Overall postoperative complications, including wound complications, were higher in the TXA group at 26% vs 12% but this was not statistically significant (p-value = 0.086). The preoperative to postoperative change in hemoglobin/hematocrit levels was not statistically significant between groups (p-value = 0.78). There was one transfusion required in the non-TXA group and no transfusions required in the TXA group (p=0.9). Conclusion: The use of TXA was not found to provide a beneficial effect in total ankle arthroplasty in either decreasing wound complications or blood loss. Given these results, TXA use might not be cost effective in total ankle arthroplasty as opposed to other total joint arthroplasties. Further higher levels studies with increased number of patients are required to further evaluate TXA effectiveness in TAA.

scholarly journals Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

2020 ◽  
Author(s):  
Zhimeng Wang ◽  
Yao Lu ◽  
Qian Wang ◽  
Leilei Song ◽  
Teng Ma ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Tibial Plateau ◽  
Adverse Reactions ◽  
Saline Solution ◽  
Physiological Saline ◽  
Wound Complications ◽  
Control Group ◽  
Vascular Events ◽  
Physiological Saline Solution

Abstract Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedics. However, no study has investigated TXA in complex tibial plate surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of IV (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the IV group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution before 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared for the three groups.The pain functional and quality of life (QoL) assessment based on their corresponding scoring system. Results Baseline data were comparable for all groups. The IV group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 29.4 ml, 219.3 ± 33.4 ml, respectively, all p values < 0.001). The topical group performed excellently with regard to postoperative vascular events, wound complications, and adverse reactions, but there was no statistical significant in the incidence of these between the groups.In addition, the topical group benefited in reducing postoperative pain and better QoL. Conclusion This study presents the first information to show that both IV TXA and topical TXA are safe and effective for complex tibial plateau fractures. The IV regimen effectively reduced blood loss during the perioperative period, whereas the topical regimen had a better safety profile and QoL.

Effect of Postoperative Oral Antibiotics on Infections and Wound Healing Following Foot and Ankle Surgery

2020 ◽  
Vol 41 (12) ◽  
pp. 1466-1473
Author(s):  
Jacob Carl ◽  
Trevor J. Shelton ◽  
Kevin Nguyen ◽  
Isabella Leon ◽  
Jeannie Park ◽  
...  
Keyword(s):  
Wound Healing ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Wound Complications ◽  
Oral Antibiotic ◽  
Foot And Ankle ◽  
Oral Antibiotics ◽  
Infection Rates ◽  
Level Of Evidence ◽  
Ankle Surgery

Background: There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified. Methods: A retrospective chart review of 649 patients was performed who underwent elective foot and ankle surgery. Six hundred thirty-one patient charts were included in the final analysis. Evaluated were patients who did and did not receive postoperative oral antibiotics in order to identify whether a difference in infection rate or wound healing occurred. The study also evaluated risk factors for developing infection following foot and ankle surgery. Results: The number of infections in patients receiving postoperative oral antibiotics was 6 (3%), while the number of infections in those who did not receive postoperative oral antibiotics was 10 (2%) ( P = .597). The difference of deep versus superficial infections and delays in wound healing between the 2 groups was not statistically significant. Patients who developed infections were older and had a higher prevalence of hypertension, a history of neoplasm, and a greater American Society of Anesthesiologists Classification of Physical Health. Conclusion: This study suggests that routine use of postoperative antibiotics in foot and ankle surgery does not affect wound complications or infection rates. Additionally, patients who are older and those with multiple medical problems may be at higher risk for developing postoperative infection following foot and ankle surgeries. Level of Evidence: Level III, retrospective comparative series.

Does perioperative use of tranexamic acid in hip fracture patients increase the risk of venous thromboembolism and reduce the need for postoperative transfusions?

2020 ◽  
Vol 30 (12) ◽  
pp. 378-382
Author(s):  
James Geddes ◽  
Greg McConaghie
Keyword(s):  
Venous Thromboembolism ◽  
Hip Fracture ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Fractures ◽  
Hip Fracture Surgery ◽  
Postoperative Blood Transfusion ◽  
Increased Risk ◽  
Fracture Surgery ◽  
Postoperative Haemoglobin

Perioperative tranexamic acid use is a popular choice among many surgeons for reducing surgical blood loss and its sequelae. While there is evidence in the literature that tranexamic acid use is effective in reducing blood loss in surgery for patients with hip fractures, there is less information on whether it leads to thromboembolic complications. We undertook a retrospective study in patients with hip fractures at two local hospitals to investigate if there was an increased risk of venous thromboembolism in patients who received tranexamic acid, and whether it reduced perioperative blood loss and the need for transfusion. We found that tranexamic acid used in patients undergoing hip fracture surgery reduced the drop in postoperative haemoglobin and the need for postoperative blood transfusion but was not associated with an increased risk of venous thromboembolism.

scholarly journals Efficacy of Short and Mono segment Spinal Fixations in Traumatic Incomplete Thoracolumbar Burst Fractures

2019 ◽  
Vol 15 (3) ◽  
pp. 197-201
Author(s):  
Binod Bhattarai ◽  
Sashi Shah
Keyword(s):  
Blood Loss ◽  
Thoracolumbar Spine ◽  
Time Lapse ◽  
Long Term Results ◽  
Wound Complications ◽  
Thoracolumbar Burst Fractures ◽  
Spinal Implant ◽  
Implant Placement ◽  
Burst Fractures ◽  
Potential Benefits

Background: Controversies still mount over the long segment, short segment and mono segment screw fixation for traumatic thoracolumbar spine burst fractures. This article aims to provide our initial experience of the effectiveness of these management modalities with additive focus on their potential benefits upon preventing the loss of correction over time. Methods: We included all operated cases of thoracolumbar fractures presenting with the ASIA grade of above ‘C’ between December 2014to December 2017 in a retrospective manner in terms of operative time, estimated intra-operative blood loss, any post-operative surgical wound complications, implant cost, average time lapse for the patients to return to physiotherapy and the follow up radiological imaging at 6 months. Results: Long segment fixation is comparatively more time consuming with considerable blood loss and high incidence of postoperative wound complications. We observed that both short as well as mono segment crew fixations had similar incidences with regards to the common complications pertaining to the spinal implant placement procedures. Conclusions: Both short and mono-segment fixation procedures resulted in comparable short and long term results. Though long segment fixation is comparatively more stable, it is, however, expensive with a higher incidence of other postoperative complications.

scholarly journals Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial

2021 ◽  
Vol 10 (15) ◽  
pp. 3272
Author(s):  
Man-Soo Kim ◽  
In-Jun Koh ◽  
Yong-Gyu Sung ◽  
Dong-Chul Park ◽  
Won-Jun Ha ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
High Tibial Osteotomy ◽  
Total Blood Loss ◽  
Wound Complications ◽  
Control Group ◽  
Transfusion Rate ◽  
Tibial Osteotomy ◽  
Total Blood ◽  
Wedge High Tibial Osteotomy

(1) Background: the purpose of this study was to investigate the efficacy and safety of intravenous (IV) administration of tranexamic acid (TXA) in patients undergoing medial opening wedge high tibial osteotomy (MOWHTO). (2) Methods: a total of 73 patients were randomly allocated into two groups (TXA group and control group). The primary outcome was total perioperative calculated blood loss after MOWHTO. Secondary outcomes included self-reported pain severity using a 10-point visual analog scale (VAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire. The postoperative allogeneic transfusion rate and wound complications were compared. Deep vein thrombosis (DVT) incidence was compared by conducting DVT computed tomography imaging. (3) Results: the total blood loss after surgery was 470.9 mL in the TXA group and 739.3 mL in the control group, showing a significant difference (p < 0.001). There were no differences in pain VAS scores between the two groups (all p > 0.05). No difference in preoperative EQ-5D scores for any items existed between the two groups. No transfusion was performed in either group. There was no difference in DVT incidence or the rate of wound complications between the two groups. (4) Conclusion: in patients undergoing MOWHTO, IV TXA reduces total blood loss and drainage amount. However, no additional benefits in clinical outcomes, transfusion rate, or wound complications were apparent, with similar DVT incidence rates.

Postoperative administration of tranexamic acid as approach to reduce blood loss after open-heart surgery

2020 ◽  
Vol 76 (1) ◽  
pp. 43-49
Author(s):  
Florian Meissner ◽  
Katrin Plötze ◽  
Klaus Matschke ◽  
Thomas Waldow
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Postoperative Blood Loss ◽  
Open Heart ◽  
Reduce Blood Loss ◽  
Perioperative Bleeding ◽  
Increased Risk ◽  
Postoperative Administration

BACKGROUND: Tranexamic acid (TXA) reduces perioperative bleeding among patients undergoing heart surgery. It is uncertain whether its postoperative administration, after prior administration before cardiopulmonary bypass (CPB), has an additional benefit. OBJECTIVE: Our study aimed to evaluate whether the postoperative administration of TXA reduces the blood loss after heart surgery. METHODS: In a retrospective cohort study at the University Heart Center Dresden, patients who underwent on-pump open-heart surgery and received 1 g TXA before CPB were included. Patients with postoperative administration of 1 g TXA were compared to patients without. Primary endpoint was the postoperative blood loss within 24 hours. RESULTS: Among 2,179 patients undergoing heart surgery between 1 July 2013 and 31 October 2014, 92 (4.2%) received TXA postoperatively. After matching, 71 patients with postoperative administration of TXA were compared to 71 without (n = 142). Postoperative administration of TXA did not result in decreased blood loss (MD 146.7 mL; p = 0.064). There was no evidence of an increased risk for thromboembolic complications. CONCLUSIONS: The postoperative administration of TXA did not reduce blood loss. The use of TXA was shown to be safe in terms of thromboembolic events and hospital mortality. Unless there is no clear evidence, the postoperative administration of TXA should be restricted to patients with massive blood loss and signs of hyperfibrinolysis only.

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