Combined use of intravenous and topical tranexamic acid in patients aged over 70 years old undergoing total hip arthroplasty

Abstract Purpose The present study was designed to evaluate the efficacy and safety of combined use of intravenous (IV) TXA administration and topical intraarticular tranexamic acid (TXA) strategy in patients aged over 70 undergoing total hip arthroplasty (THA). Methods One hundred eighty patients were randomized into three groups, including an IV group, a local group, and a combined group. Patients were administrated with 15 mg/kg of IV-TXA in the IV group, 2 g TXA in the topical group, or 15 mg/kg IV-TXA combined with 2 g TXA in the combined group. Total blood loss (TBL), maximum hemoglobin drop, the transfusion rate and the number of allogeneic blood units, and the incidence of deep venous thrombosis (DVT), and pulmonary embolism (PE) were recorded and analyzed. Results TBL was 757.75 ± 188.95 mL in the combined group, which was significantly lower than in the IV group (892.75 ± 218.47) or the topical group (1015.75 ± 288.71) (p = 0.015, p = 0.001 respectively). The mean values of maximum hemoglobin drop in the combined, IV, and topical groups were 2.67 ± 0.42, 3.28 ± 0.52, and 3.75 ± 0.62 g/dL, respectively, with a significant intergroup difference (p < 0.001 for all). PE was not detected within 1 month after the surgery. Asymptomatic DVT was reported in 1 patient of the IV group, and in 2 patients from the combined group, while the difference was not statistically significant. Conclusions Compared to intravenous or topical use of TXA, the combined therapy effectively decreased total blood loss and reduced the transfusion rate, simultaneously possessed the same degree of safety in primary THA patients aged over 70.

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A STUDY ON COMBINED USE OF INTRAVENOUS AND TOPICAL TRANEXAMIC ACID FOLLOWING CEMENTLESS TOTAL HIP ARTHROPLASTY- A RANDOMISED CLINICAL TRIAL

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i12.808 ◽

2019 ◽

Vol 3 (5) ◽

Author(s):

Romil Rathi ◽

Anurag Chandrakar

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Local Group ◽

Total Blood Loss ◽

Complication Rates ◽

Total Blood ◽

Total Hip ◽

Combined Use

Purpose: This study was designed to compare the efficacy and safety of the combined use of tranexamic acid (TXA) with the intravenous (IV) or local use alone in total hip arthroplasty (THA). Methods: 21 patients were randomised to a IV group, a local group or a combined group. Participants received 1.5 g IV-TXA in the IV group, 3 g local TXA in the local group, or 1 g IV-TXA combined with 2 g local TXA in the com- bined group. The primary outcomes were total blood loss (TBL), maximum haemoglobin drop, and the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE). Results: TBL was (77.65 ± 18.95) ml in the combined group, which was significantly lower than in the IV group or the local group (p = 0.015, p = 0.001 respectively). Likewise, the mean values of maximum hemoglobin drop in the combined, IV, and local groups were 2.98 ± 0.78, 3.36 ± 0.78, and 3.89 ± 0.72 g/dL, respectively, with a significant intergroup difference (p<0.001 for all). Asymptomatic DVT was detected in 1 patient of the IV group, and 2 patients of the combined group with the use of ultrasound. There were no episodes of PE, and no significant differences were seen between groups in terms of complications. Conclusions: Combined use of intravenous TXA and local TXA in primary unilateral THA can effectively decrease total blood loss and increase postoperative haemoglobin levels without influencing complication rates. It is sug- gested that this combined TXA regimen is more effective in decreasing blood loss in cementeless THA than intra- venous or local administration alone. Keywords: Tranexamic acid, Total hip arthroplasty, Blood loss, Transfusion, Combined treatment

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Less blood loss in supercapsular percutaneously assisted versus posterolateral total hip arthroplasty

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02363-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yong Hu ◽

Min-Cong Wang ◽

Tao Wang ◽

Yue Meng ◽

Xiao-Min Chao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Total Blood Loss ◽

Transfusion Rate ◽

Operative Blood Loss ◽

Total Blood ◽

Radiographic Findings ◽

Total Hip ◽

Affected Side

Abstract Background Although excellent clinical outcomes of supercapsular percutaneously assisted total hip arthroplasty (SuperPath) have been reported, the peri-operative blood loss has rarely been reported. The current study determined the blood loss during SuperPath and compared the blood loss with conventional posterolateral total hip arthroplasty (PLTH). Methods This retrospective study enrolled patients who underwent unilateral primary THA between January 2017 and December 2019. The demographic data, diagnoses, affected side, radiographic findings, hemoglobin concentration, hematocrit, operative time, transfusion requirements, and intra-operative blood loss were recorded. The peri-operative blood loss was calculated using the OSTHEO formula. Blood loss on the 1st, 3rd, and 5th post-operative days was calculated. Hidden blood loss (HBL) was determined by subtracting the intra-operative blood loss from the total blood loss. Results Two hundred sixty-three patients were included in the study, 85 of whom were in the SuperPath group and 178 in the posterolateral total hip arthroplasty (PLTH) group. Patient demographics, diagnoses, affected side, operative times, and pre-operative hemoglobin concentrations did not differ significantly between the two groups (all P > 0.05). Compared to the PLTH group, the SuperPath group had less blood loss, including intra-operative blood loss, 1st, 3rd, and 5th post-operative days blood loss, and HBL (all P < 0.05). Total blood loss and HBL was 790.07 ± 233.37 and 560.67 ± 195.54 mL for the SuperPath group, respectively, and 1141.26 ± 482.52 and 783.45 ± 379.24 mL for the PLTH group. PLTH led to a greater reduction in the post-operative hematocrit than SuperPath (P < 0.001). A much lower transfusion rate (P = 0.028) and transfusion volume (P = 0.019) was also noted in the SuperPath group. Conclusion SuperPath resulted in less perioperative blood loss and a lower transfusion rate than conventional PLTH.

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499020959516 ◽

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.

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Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1497-y ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Xingming Xu ◽

Jiang Jiang ◽

Wei Liu ◽

Xiaofeng Li ◽

Huading Lu

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Perioperative Complications ◽

Control Groups ◽

Total Blood ◽

Total Hip ◽

Coagulation Function ◽

And Control

Abstract Background Tranexamic acid (TXA) is widely used to reduce blood loss and transfusion rates in total hip arthroplasty(THA). Thromboelastography, which can monitor coagulation changes from clotting to fibrinolysis dynamically. In this study, thromboelastography was used to assess the dynamic changes in the coagulation of patients who underwent THA with the administration of TXA. Methods This randomized controlled trial consisted of 207 consecutive patients who underwent primary total hip arthroplasty. Patients were randomized into three groups: topical-TXA group received a topical application of TXA, IV-TXA group received an intravenous injection of TXA, and control group. Thromboelastography was performed 1 day before surgery and first, fourth, seventh days after surgery. The primary outcomes were thromboelastography parameters, the rates of deep vein thrombosis(DVT), and pulmonary embolism(PE). Secondary outcomes included perioperative blood loss, transfusion rates, and other perioperative complications. Results The mean calculated total blood loss in the Topical-TXA group were 832.7 ± 279.84 ml and 834.8 ± 322.94 ml in the IV-TXA group, which were significantly reduced (p < 0.05) compared with control groups at 1093.3 ± 379.7 ml. There were no significant differences between topical-TXA and IV-TXA groups in total blood loss or transfusion rates. K and R have reached a nadir from preoperative levels to 4th day postoperatively and then began to increase.α angle and CI peaked from preoperative levels to the fourth day postoperatively and then began to decline.IV-TXA significantly (p < 0.05) promoted coagulation levels compared with topical-TXA and control groups in the early postoperative period. Almost no significant differences were observed between topical-TXA and control groups in thromboelastography parameters.No significant differences were observed in the incidence of thromboembolic complications and other perioperative complications. Conclusions The topical administration of TXA had the same hemostatic effect as intravenous injection tranexamic acid. Coagulation function peaked on 4th day postoperatively and then began to decline. IV-TXA was more enhanced coagulation functions compared with topical-TXA.

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Effect of Additional Administration of Topical Tranexamic Acid in Patients Undergoing Primary Total hip Arthroplasty Without Drainage

10.21203/rs.3.rs-151736/v1 ◽

2021 ◽

Author(s):

Jing Yao Jin ◽

Qing Song Li ◽

Taek Rim Yoon ◽

Sheng Yu Jin ◽

Min Gwang Kim ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Propensity Score ◽

Blood Loss ◽

Tranexamic Acid ◽

Propensity Score Matching ◽

Hip Arthroplasty ◽

Total Blood ◽

Total Hip ◽

Topical Tranexamic Acid ◽

Primary Total Hip Arthroplasty

Abstract Introduction: This study was designed to compare the clinical results of additional administration of topical tranexamic acid (TXA) with intravenous TXA (IV-TXA) and to determine its effect in patients undergoing primary total hip arthroplasty (THA) without drainage using propensity score matching analysis.Methods: A total of 248 patients (248 hips) underwent primary THA from March 2016 to June 2018. Patients who received topical TXA and IV-TXA were included in the combined group (46 patients), and patients who received IV-TXA were included in the IV only group (202 patients). After propensity score matching, both groups consisted of 44 patients (88 patients in total). We compared the results of total blood loss (TBL), haemoglobin (Hb) level, Hb drop, and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). Results: In the combined group, the TBL was 280.4 ± 64.2 mL, which was significantly lower than that in the IV only group (335.3 ± 75.3 mL; p < 0.001). From the preoperative period to 1-week postoperatively, Hb levels were not significantly different between the two groups. There was significantly more Hb drop in the IV only Group from immediate postoperative to postoperative day 3 (POD 3). In both groups, no patient presented with postoperative symptomatic DVT or PE. Conclusion: In patients undergoing primary THA without drainage, combined use of IV-TXA and topical TXA can significantly decrease blood loss without influencing postoperative complications.

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

The Journal of Hip Surgery ◽

10.1055/s-0039-3402038 ◽

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.

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

Bone and Joint Research ◽

10.1302/2046-3758.106.bjr-2020-0357.r2 ◽

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.

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Combined Use of Intravenous and Topical Tranexamic Acid Efficiently Reduce Blood Loss in Patients Aged over 60 operated with 2-level lumbar fusion

10.21203/rs.2.22192/v2 ◽

2020 ◽

Author(s):

Jianjiang Li ◽

Long Wang ◽

Tao Bai ◽

Yanlu Liu ◽

Yifei Huang

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Lumbar Fusion ◽

Control Group ◽

Transfusion Rate ◽

Total Blood ◽

Fusion Surgery ◽

Combined Use ◽

Group A ◽

Hemoglobin Drop

Abstract Purpose: The current study was conducted to assess the efficacy and safety of the intravenous (IV) administration combined with topical administration of tranexamic acid （TXA）in patients (aged over 60) scheduled for 2-level lumbar fusion surgery. Methods: 280 patients scheduled for 2-level lumbar fusion surgery were randomized into four groups, including an IV group, a local group, a combined group, and a control group. Patients in the combined group, in the IV group, in the topical group, and in the control group were administrated with 15 mg/kg of IV-TXA + 2 g TXA in local,15 mg/kg IV-TXA, 2 g TXA in local ,and 100 ml IV, respectively. The results of total blood loss (TBL) , maximum hemoglobin drop, the transfusion rate, and the number of allogeneic blood units were compared. Deep venous thrombosis (DVT) and pulmonary embolism (PE) events were monitored and recorded. Results: The TBL was 635.49 ± 143.60, 892.62 ± 166.85, 901.11 ± 186.25, and 1,225.11 ± 186.25 mL for the combined group, the IV group, the topical group, and the control group, respectively.(p = 0.015, p = 0.001 respectively).The average maximum hemoglobin drop in the four above groups was 2.18 ± 0.24, 2.80 ± 0.37, 2.40 ± 0.64 ，and 3.40 ± 1.32 g/dL, respectively. No PE event was reported during the follow-up. Although asymptomatic DVT events was reported by 1, 2, and 2 patients in the combined group, topical group, and control group, respectively, there is no intergroup difference. Conclusions: The combined use of TXA effectively reduced total blood loss and blood transfusion rate in patients aged over 60 scheduled for 2-level lumbar fusion, without increasing the incidence of DVT and PE formation.

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Evaluation of tranexamic acid after total hip arthroplasty over 60 years old in China: a Systematic Review and Meta-analysis

10.37766/inplasy2022.1.0048 ◽

2022 ◽

Author(s):

Pan Luo ◽

◽

Fuqiang Gao ◽

Nianfei Zhang ◽

Hongwei Yu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Full Text ◽

Meta Analysis ◽

Measurement Data ◽

Pooled Analysis ◽

Transfusion Rate ◽

Total Blood ◽

Total Hip

Review question / Objective: The purpose of this meta-analysis was to evaluate the efficacy of tranexamic acid after total hip arthroplasty in patients older than 60 years old in China by meta-analysis. Participant or population: All trials included in our study meet the following criteria: (1) All studies were original RCTs; (2) The mean age of patients for each study was ≥ 60 years old; (3) Patients were received total hip arthroplasty in all studies; (4) All studies included oral and iv or topical groups, with a comparison of outcomes between the two groups; (5) The full text of the included literature can be obtained, and the measurement data of hemoglobin drop, total blood loss, transfusion rate, complication, length of stay can be extracted. The following studies were excluded from the meta-analysis: nonrandomized studies; the patients with age<60; studies not suitable with the inclusive criteria; and articles for which we were unable to obtain the full text and relevant data for pooled analysis.

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