scholarly journals Comparison of weight-based versus standard dosing of tranexamic acid for blood loss and transfusion amount in knee arthroplasty without tourniquet

2019 ◽  
Author(s):  
olcay guler ◽  
Engin Çarkçı ◽  
Mehmet Halis Çerci ◽  
Gürkan Gümüşsuyu ◽  
Çağatay Öztürk
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Scoring Systems ◽  
Study Groups ◽  
Acid Group ◽  
Skin Incision ◽  
Retrospective Case ◽  
Significant Difference ◽  
Without Tourniquet

Abstract Backgruond To compare weight-based versus standard dosing of intravenous (IV) tranexamic acid for blood loss and transfusion amount in total knee arthroplasty (TNA) without tourniquet. Methods A total of 99 patients who underwent TNA with the diagnosis of primary osteoarthritis were enrolled in this retrospective case-control study. Patients were divided into two groups according to the application of tranexamic acid. Group 1 (weight-based dosing): 10 mg/kg IV TA 30 min before the skin incision, and 10 mg/kg, at postoperative 30 min, and 3 h. Group 2 (standard dosing): 1 g of IV TA 30 min before skin incision, and 1 g at postoperative 30 min and 3 h. Hemoglobin levels, before, and 1, and 2 days after the operation, postoperative amount of decrease in hemoglobin levels, and amount of erythrocyte transfusion were recorded. Two scoring systems Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were applied in the evaluation of TNA results preoperatively, and at 1., 3., 6., and 12. months, postoperatively. Results Both groups did not differ from each other by means of age (p=0.127), gender (p=0.528), BMI (p=0.782), operating sides (p=0.544), existing comorbidities (p=0.987), preoperative hemoglobin level (p=0.718), the amount of hemoglobin reduction (p=0.769), and the amount of erythrocytes transfused (p=0.913). In both study groups, hemoglobin levels in male patients dropped significantly more deeply than female patients. Also, in both study groups, hemoglobin levels were significantly lower in patients with comorbid illnesses. A statistically significant difference was not detected between Groups 1 and 2 in terms of pre- and postoperative WOMAC scores, KSS knee scores, and KSS function scores. Conclusion Our study showed that weight-based and standard dosing of IV tranexamic acid treatments were similar in efficacy and safety. Both treatments reduce blood loss and the need for transfusion. Also, there was no significant difference in terms of reliability between the two groups.

Bipolar Sealers Do not Improve Blood Loss or Functional Outcomes of Primary Total Knee Arthroplasty

2018 ◽  
Vol 33 (01) ◽  
pp. 062-066
Author(s):  
Stefano Pasqualotto ◽  
Guillaume Demey ◽  
Aude Michelet ◽  
Luca Nover ◽  
Mo Saffarini ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Transfusion Rate ◽  
Significant Difference ◽  
Functional Scores ◽  
Bipolar Sealer ◽  
Total Knee ◽  
Without Tourniquet

AbstractSeveral methods were introduced to limit perioperative blood loss in total knee arthroplasty (TKA). By transcollation of soft tissues below 100°C, bipolar sealers intend to reduce bleeding and tissue damage, compared with conventional electrocautery. Existing studies report contradictory findings about the performance of bipolar sealers. The purpose of this study was to evaluate the effect of a bipolar sealer on blood loss, transfusions, hospital length of stay (LOS), and functional scores in primary TKA. In this single-center prospective study, 101 patients, undergoing primary TKA in a fast-track setting without tourniquet use, were randomly assigned to either (1) the study group which was operated with a bipolar sealer or (2) the control group operated with conventional electrocautery. The study cohort comprised 49 men and 52 women, aged 71.1 ± 8.8 years. There was no significant difference between the bipolar sealer group and the control group in terms of blood loss at day 3 (1,240 ± 547.4 vs. 1,376 ± 584.4 mL; p = ns [not significant]), transfusion rate (10 vs. 4%; p = ns), surgery time (48.2 ± 10.8 vs. 46.6 ± 9.1 minute; p = ns) or LOS (4.1 ± 2.7 vs 4.3 ± 2.0 days; p = ns). At a mean follow-up of 63.3 ± 4.9 days, there was no significant difference between the bipolar sealer group and the control group in terms of net improvement of Knee Society Score (KSS) knee (26.0 ± 16.7 vs. 23.7 ± 12.3; p = ns) and KSS function (20.4 ± 19.3 vs. 20.8 ± 19.9; p = ns). Compared with the use of conventional electrocautery in primary TKA without tourniquet, we found no effect of bipolar sealer use on blood loss, transfusion rates, LOS, or functional recovery. This is a Level II, prospective cohort study.

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 Effect of Tranexamic Acid after Cardiac Surgery in Children

1970 ◽  
Vol 1 (2) ◽  
pp. 189-192
Author(s):  
MK Hassan ◽  
KA Hasan ◽  
ABMA Salam ◽  
A Razzak ◽  
S Ferdous ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Pediatric Patients ◽  
Acid Group ◽  
Skin Incision ◽  
Total Blood Loss ◽  
Financial Cost ◽  
Total Blood ◽  
Transfusion Requirements

Background: The antifibrinolytic drug tranexamic acid (TA) decreases blood loss in Pediatric patients under going cardiac Surgery. However its efficacy has not been extensively studied in children. Method: We examined 750 children under going cardiac surgery form 2004 to 2007 in National Institute of Cardiovascular Diseases (NICVD), 379 children in the Tranexamic Acid group (TA) and 371 included in placebo (P) group. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (10mg/kg followed by 1mg/kg/hr) and saline placebo. After admission to intensive care unit total blood loss and transfusion requirements during the first12 hours were recorded. Result: Children who were treated with tranexamic acid had 24% less total blood loss (26±7 vs 34±17 ml/kg) compared with children who received placebo (p<0.05). Additionally, the total transfusion requirements, total donor unit exposure and financial cost of blood components were less in the tranexamic acid group. Conclusion: Tranexamic acid can reduce perioperative blood loss in children undergoing cardiac surgery.Keywords: Tranexemic acid; Cardiac surgery; Post operative; bleeding DOI: http://dx.doi.org/10.3329/cardio.v1i2.8127 Cardiovasc. j. 2009; 1(2) : 189-192

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 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.

scholarly journals Significantly reducing blood loss via a peri-articular injection of tranexamic acid during total knee arthroplasty: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yu-Kuan Lin ◽  
Shang-Wen Tsai ◽  
Po-Kuei Wu ◽  
Chao-Ming Chen ◽  
Jesse Chieh-Szu Yang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Transfusion Rate ◽  
Group I ◽  
Significant Difference ◽  
Total Knee ◽  
Group Ii

Abstract Background The administration of an intra-articular injection (IAI) of tranexamic acid (TXA) has been demonstrated to be effective in reducing both blood loss and transfusion rate during total knee arthroplasty (TKA); however, few studies have reported the efficiency of a peri-articular injection (PAI) of TXA. We studied the efficiency of a PAI of TXA in reducing blood loss during TKA. Methods Fifty patients undergoing primary simultaneous bilateral TKA were enrolled in this retrospective study. The right knee received a PAI of 1 g of TXA (Group I), and the left knee received an IAI of 1 g of TXA (Group II). The clinical outcome measures were a change in blood loss from Hemovac drains and surgical time. Results The decrease in blood loss from the Hemovac was significantly lower in Group I (460.1 ± 36.79 vs. 576.0 ± 34.01, P < 0.001) than in Group II, and no significant difference in surgical times was observed. The blood transfusion rate in the present study was 16 %. Conclusions A PAI of TXA may reduce blood loss more efficiently than an IAI of TXA during TKA without increased complications such as surgical site infection, poor wound healing, skin necrosis, pulmonary embolism, and deep vein thrombosis.

scholarly journals Significantly Reducing Blood Loss Using Intra-muscular Injection of Tranexamic Acid during Total Knee Arthroplasty

2020 ◽  
Author(s):  
Yu-Kuan Lin ◽  
Shang-Wen Tsai ◽  
Po-Kuei Wu ◽  
Chao-Ming Chen ◽  
Jesse Chieh-Szu Yang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Transfusion Rate ◽  
Reduce Blood Loss ◽  
Group I ◽  
Significant Difference ◽  
Total Knee ◽  
Group Ii

Abstract Background Administration of an intra-muscular injection (IMI) of tranexamic acid (TXA) had been demonstrated to be effective in reducing both blood loss and the transfusion rate during total knee arthroplasty (TKA). However, few studies have reported on the efficiency of IMI of TXA. We studied the efficiency of IMI of TXA to reduce blood loss during TKA. Methods In this prospective study, 50 patients undergoing primary simultaneous bilateral TKA were enrolled. The right knee received a IMI of 1 g of TXA (Group I), and the left knee received an intra-articular injection (IAI) of 1 g of TXA (Group II). The clinical outcome measures were a change in hemoglobin levels, blood loss from Hemovac, and number of allogeneic blood units. Results Compared with Group II, the decrease in blood loss from Hemovac was significantly less for Group I (460.1 ± 36.79 vs. 576.0 ± 34.01, P < 0.001), and no significant difference in surgical times was observed. Conclusions IMI of TXA can significantly reduce blood loss than IAI of TXA during TKA without increased complications such as surgical site infection, poor wound healing, skin necrosis, pulmonary embolism, and deep vein thrombosis.

Comparison of efficacy of tranexamic acid irrigation versus intravenous injection for preventing blood loss in percutaneous nephrolithotomy

2021 ◽  
pp. 205141582110596
Author(s):  
Sunirmal Choudhury ◽  
Avisek Dutta ◽  
Dilip Kumar Pal
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Percutaneous Nephrolithotomy ◽  
Acid Group ◽  
Saline Group ◽  
Total Blood ◽  
Acid Irrigation ◽  
Significant Difference ◽  
Irrigation Solution ◽  
Group 2

Purpose: Bleeding is the most dreadful and distressing complication of percutaneous nephrolithotomy, which can cause significant morbidity. Intravenous use of tranexamic acid to reduce bleeding complication is widely established. Our aim is to compare the result between the two groups using tranexamic acid intravenous and in irrigation solution. Materials and methods: A total of 160 patients were enrolled in this study. Patients were randomly allocated to two groups. Group 1 received 0.1% tranexamic acid solution (1000 mg in 1 L of irrigation solution (normal saline)). Group 2 received 1 g tranexamic acid intravenously in intraoperative period. Results: The mean estimated fall in haematocrit, mean estimated total blood loss and mean operative time in tranexamic acid irrigation group is significantly less compared to intravenous tranexamic acid group. No significant difference was found with regards to stone clearance. Conclusion: We found that tranexamic acid irrigation was safe and associated with reduced blood loss as compared to intravenous tranexamic acid.

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