scholarly journals Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao-Yang Wang ◽  
Liu Wang ◽  
Ze-Yu Luo ◽  
Duan Wang ◽  
Xin Tang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Blood ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

scholarly journals Multiple-dose tranexamic acid for perioperative blood loss in total knee arthroplasty in patients with rheumatoid arthritis：a single-blinded, randomised, parallel-controlled study protocol in China

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e034431
Author(s):  
Bing-Xin Kang ◽  
Hui Xu ◽  
Chen-Xin Gao ◽  
Sheng Zhong ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Intravenous Injection ◽  
Knee Arthroplasty ◽  
Multiple Dose ◽  
Controlled Study ◽  
Group A ◽  
Total Knee ◽  
Group B

IntroductionThis clinical trial is designed to evaluate the effect of multiple-dose tranexamic acid (TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA).Methods and analysisA randomised, single-blinded, parallel-controlled study will be designed. Patients with RA (age 50–75 years) undergoing unilateral primary end-stage total knee arthroplasty will be randomly divided into group A or group B. Group A will be treated with one dose of TXA (1 g; intravenous injection 3 hours postsurgery) and group B with three doses (1 g; intravenous injection at 3, 6 and 12 hours postsurgery) after surgery. The primary outcomes will be evaluated with blood loss, maximum haemoglobin drop and transfusion rate. The secondary outcomes will be evaluated with knee function and complications.Ethics and disseminationThe Shanghai Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine Ethics Committee approved in this study in July 2019. Informed consent will be obtained from all participants. Results of the trial will be published in the Dryad and repository in a peer-reviewed journal. Additionally, deidentified data collected and analysed for this study will be available for review from the corresponding author on reasonable request.Trial registration numberChiCTR1900025013.

Comparison the Postoperative Blood Loss in Total Knee Arthroplasty with and without Perioperative Tourniquet Release

2021 ◽  
Vol 15 (5) ◽  
pp. 1142-1143
Author(s):  
S. Aziz ◽  
S. Ahmed ◽  
S. A. Mahar ◽  
S. Ali ◽  
J. Kumar
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Postoperative Blood Loss ◽  
Keywords Total Knee Arthroplasty ◽  
Significant Difference ◽  
Tourniquet Release ◽  
Group A ◽  
Total Knee ◽  
Group B

Objective: To compare the postoperative blood loss in total knee arthroplasty with and without perioperative tourniquet release. Study Design: Randomized control trial Place & Duration of Study: Department of Orthopaedic, M. Islam Teaching Hospital Gujranwala 1st January 2020 to 31st December 2020. Methodology: Ninety patients of both genders undergoing total knee arthroplasty were included in this study. Patient’s demographics were recorded after written consent. Patients were equally divided into two groups. Group A (45 patients) received total knee arthroplasty with tourniquet while group B (45 patients) received total knee arthroplasty without tourniquet. Postoperative blood loss was measured by suction drain, levels of haemoglobin were examined and compare between two groups. Results: The mean age of the patients in group A was 57.76±2.4 years while in group B it was 58.16±7.8 years. 32 (71.11%) and 34 (75.56%) were males while 13 (28.89%) and 11 (24.44%) were females in group A and B. We observed patients at the three different points and found lower blood loss in patients who received total knee arthroplasty with tourniquet as compared to no tourniquet group (p-value <0.05). No significant difference was observed regarding hemoglobin at 2 hours and significant differences were observed at 24 and 48 hour postoperatively. Conclusion: Tourniquet is useful to decrease loss of blood in patients undergoing total knee arthroplasty. Keywords: Total knee arthroplasty (TKA), Tourniquet, Blood loss

scholarly journals Multiple-Dose Intravenous Tranexamic Acid in Total Knee Arthroplasty in Patients with Rheumatoid Arthritis: A Randomized Controlled Study

2020 ◽  
Author(s):  
Bing-xin Kang ◽  
Hui Xu ◽  
Chen-xin Gao ◽  
Sheng Zhong ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Randomized Controlled ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
D Dimer

Abstract Background: To identify the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who underwent primary unilateral total knee arthroplasty (TKA).Methods: In this single-center, single-blind randomized controlled clinical trial, ten male and 87 female participants aged 50–75 years, with RA who underwent unilateral primary TKA were randomly assigned (1:1) to receive a single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total red blood cell loss (TBL), hidden red blood loss (HBL) and maximum hemoglobin (Hb) drop. Secondary outcomes were transfusion rate and levels of D-dimer. All parameters were measured post-operatively during inpatient hospital stay.Results: Between September 2019 and May 2020, 104 participants were randomized. 7 were lost follow-up. Mean TBL, HBL, and maximum Hb drop in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in groups A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. D-dimer level was lower in group B than in group A on post-operative day 1 (P < 0.001), and the incidence of thromboembolic events was similar between the two groups (P > 0.05). Conclusion: Three doses of post-operative IV-TXA could further reduced blood loss, maximum Hb drop, and diminished the postoperative fibrinolytic responses without increasing the risk of complications.Trial registration: The trial was registered in Chinese Clinical Trial Registry (ChiCTR1900025013).Name of the registry: Clinical observation of multiple dose use of tranexamic acid in patients with rheumatoid arthritis after total knee arthroplasty. Prospective registration, ChiCTR1900025013. Registered 7 August 2019, http://www.chictr.org.cn/showproj.aspx?proj=41375

scholarly journals Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bing-xin Kang ◽  
Hui Xu ◽  
Chen-xin Gao ◽  
Sheng Zhong ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Randomized Controlled ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
D Dimer

Abstract Background We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA). Methods For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50–75 years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1 g IV-TXA 10 min before skin incision, followed by articular injection of 1.5 g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay. Results The mean TBL, HBL, and maximum Hb level decrease in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in group A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 (P <  0.001), and the incidence of thromboembolic events was similar between the groups (P > 0.05). Conclusion In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900025013).

scholarly journals Use of tranexamic acid in total knee arthroplasty

Joints ◽  
2016 ◽  
Vol 04 (04) ◽  
pp. 202-213 ◽  
Author(s):  
Francesco Marra ◽  
Federica Rosso ◽  
Matteo Bruzzone ◽  
Davide Bonasia ◽  
Federico Dettoni ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Demographic Data ◽  
Level Of Evidence ◽  
Total Blood ◽  
Prospective Comparative Study ◽  
Total Knee ◽  
Student’S T

Purpose: different strategies have been developed to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. Methods: we enrolled all patients submitted to a primary TKA in our department between November 2014 and August 2015. They were divided into three groups corresponding to the method of TXA administration used: intravenous (IV), intra-articular (IA), and a combination of the two. Demographic data, as well as preoperative hemoglobin and platelet levels, were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions; postoperative pain was also assessed. Student’s t-test or a χ2 test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences. Results: the sample comprised 34 patients: IV, 10 cases; IA, 15 cases, and combined (IV + IA), 9 cases. The average age of the patients was 71.1±6.4 years. No significant differences in the outcome measures were found between the groups, with the exception of a significantly lower maximum hemoglobin loss in the combined versus the IV group (p=0.02). There were no differences between the groups in the amount of blood in the drain or the rate of transfusions. Conclusions: the data from this preliminary study, as well as data from the literature, confirm that TXA administration is safe and effective in reducing total blood loss in TKA, and no administration protocol seems to be superior to the others. Level of evidence: Level II, prospective comparative study.

scholarly journals Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yimin Zhang ◽  
Bao Lang ◽  
Guifeng Zhao ◽  
Fengming Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Total Blood Loss ◽  
Total Blood ◽  
Study Results ◽  
Total Knee

Abstract Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration

2015 ◽  
Vol 135 (4) ◽  
pp. 573-588 ◽  
Author(s):  
Hamidreza Shemshaki ◽  
Sayed Mohammad Amin Nourian ◽  
Niloofaralsadat Nourian ◽  
Masoudhatef Dehghani ◽  
Masoud Mokhtari ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Transfusion Rate ◽  
Total Blood ◽  
One Step ◽  
Total Knee ◽  
Acid Administration

scholarly journals A randomized, non-crossover, parallel-group analysis of tranexamic acid in minimizing blood loss and transfusions in total knee arthroplasty

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Nikhil Mudgalkar
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Acid Group ◽  
Total Blood Loss ◽  
Blood Transfusions ◽  
Total Blood ◽  
Parallel Group ◽  
Total Knee

Objectives: Total knee arthroplasty is associated with significant blood loss, necessitating blood transfusions. Due to the obvious risks and costs of allogeneic blood transfusions, techniques to minimize blood loss in surgery are needed. The objective of this study was to assess the efficacy of tranexamic acid treatment in reducing blood loss and blood transfusion requirements during total knee arthroplasty. Materials and Methods: A prospective, randomized, double-blind, parallel-group, non-crossover trial was carried out in Prathima Hospital, Karimnagar. The trial involved 28 ASA I and II patients undergoing unilateral knee arthroplasty, 14 in each of the control and study groups. In the study group, a 10 mg/kg bolus of tranexamic acid was administered slowly IV 30 min before tourniquet deflation, followed by a 1 mg/kg/hr infusion for 12 h, compared to the standard medical treatment in the control group. Total blood loss during and after surgery was compared between the two classes. We also compared the hemoglobin drop after surgery, the number of people who needed blood transfusions, and the number of units needed between the two classes. Any complications were also reported. Results: Total blood loss in the tranexamic acid group was 543.3 ± 184.85 versus 685.83 ± 176.74, a statistically significant difference (P < 0.05). Intraoperative blood loss was comparable, but post-operative blood loss was significantly lower in the tranexamic acid group (389.16 ± 174 ml vs. 514.36 ± 143.89 ml), indicating that it was statistically significant (P < 0.05). There were no complications reported from any of the groups. Conclusion: Tranexamic acid is an effective strategy for minimizing overall blood loss and blood transfusions in patients undergoing total knee arthroplasty.

scholarly journals Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Maolin Sun ◽  
Ying Zhang ◽  
Yang Peng ◽  
Dejie Fu ◽  
Huaquan Fan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Swing Phase ◽  
Flexion Angle ◽  
Gait Parameters ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
The Mean ◽  
Group B

Background. With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA. Methods. Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS). Results. The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P<0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P<0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference. Conclusion. 3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.

scholarly journals Effect of tranexamic acid on the timing of drainage tube removal in total knee arthroplasty

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0052
Author(s):  
Wang Jinliang ◽  
Wei Xuan
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Acid Group ◽  
Drainage Tube ◽  
Total Blood ◽  
Drainage Volume ◽  
Postoperative Drainage ◽  
Total Knee

Introduction: To investigate the effect of tranexamic acid on the removal time of drainage tube in the first unilateral total knee arthroplasty. Hypotheses: The timing of removing the drinage system can be changed when using TXA. Methods: From June 2017 to December 2018, 182 patients (42 males and 140 females) who planned to undergo primary unilateral total knee replacement were included.Age (68.1±7.1) years (60-76 years).According to the random number table method, it was divided into four groups: 45 cases of Tranexamic acid group 1 (TXA1), 46 cases of Tranexamic acid group 2 (TXA2), 46 cases of Tranexamic acid group 3 (TXA3) and None Tranexamic acid group (NTXA).TXA1-3 group intraoperative intravenous infusion combined with local application of tranexamic acid;NTXA group was locally perfused in the joint cavity with 100ml normal saline only after surgery.Differences in drainage volume, total blood loss, invisible blood loss, degree of postoperative joint swelling, Hospital for special surgery (HSS) and visual analogue scale (VAS) of pain were compared among the four groups. Results: The postoperative drainage volume of TXA1˜3 groups was 85.5±34.3ml, 189.4±72.3ml and 215.3±93.4ml, respectively, which was less than that of the non-tranexamic acid group (351.3±113.5ml). The overall difference was statistically significant (F=11.5,P=0.005). The postoperative drainage volume of tranexamic acid 1 group was less than that of tranexamic acid 2 and 3 groups.The total postoperative blood loss was 699.0±255.7ml, 710.4±296.1ml, and 715.8±248.2ml in the tranexamic acid 1-3 groups, respectively, which was less than 1130.5±354.2ml in the non-tranexamic acid group, and the overall difference was statistically significant (F=13.1,P=0.001).On the 4th day after the operation, the knee swelling degree of the tranexamic acid 1- 3 groups was 1.25±0.07, 1.13±0.12, and 1.12±0.13, respectively, which were smaller than that of the non-tranexamic acid group (1.43±0.22), and the overall difference was statistically significant (F=8.23, P=0.015).There were 2 cases of positive bacterial culture in non-tranexamic acid group and tranexamic acid group.There were 3 cases of hematoma in the non-tranexamic acid group,and 1 case of delayed wound healing. Conclusion: The application of tranexamic acid after TKA can reduce postoperative drainage volume, latent blood loss and total blood loss.The removal of the drainage tube 18h after the operation can not only fully drain,relieve pain, promote the recovery of knee joint function, but also effectively reduce the risk of infection caused by the drainage tube.

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