scholarly journals Effect of Fibrin Sealant on Knee Function Restoration Following Total Knee Replacement: A Meta-analysis

2021 ◽  
Author(s):  
Kongye Lu ◽  
Mengqi Lu ◽  
Yunlong Pei ◽  
Pengzhi Shi ◽  
Jin Zhang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Hospital Stay ◽  
Range Of Motion ◽  
Knee Replacement ◽  
Fibrin Sealant ◽  
Total Blood Loss ◽  
Transfusion Rate ◽  
Total Blood ◽  
Total Knee

Abstract Objective: The aim of present study was to evaluate the efficacy and safety of fibrin sealant on knee function restoration following total knee replacement. Methods: PubMed, Web of Science, Cohrane library, and Embase were searched up to August 2021. All prospective randomized controlled trial involving fibrin sealant treatment for total knee replacement were included in this meta-analysis. Range of motion, total blood loss, blood transfusion rate, hemoglobulin reduction, hospital stay, and complication were calculated using RevMan 5.4 software.Results: Totally 23 randomized clinical trials involving 2267 patients (1136 patients for fibrin sealant group and 1131 patients for control group) were finally included. The results indicated that that the usage of fibrin sealant in total knee replacement can reduce the total blood loss [95% (-935.81, -351.70), P<0.0001], transfusion rate [95%CI (0.47, 0.90), P=0.01], hemoglobulin reduction [95%CI (-2.94, -0.74), P=0.001] and hospital stay [95%CI (-1.76, -0.42), P=0.001] without increasing the rate of complication [95%CI (-0.04, 0.02), P=0.42], but cannot increase the knee range of motion [95%CI (-1.17,9.29), P=0.13].Conclusion: The usage of fibrin sealant can effectively reduce the total blood loss, transfusion rate, hemoglobulin reduction and hospital stay without increasing the rate of complication, but cannot increase the knee range of motion

scholarly journals A non-randomized prospective study of the blood sparing effect of tranexamic acid in total knee replacement

2016 ◽  
Vol 3 (1) ◽  
pp. 12
Author(s):  
Anand Gupta ◽  
Ashok Nagla ◽  
Vinay Tantuway ◽  
Rishi Gupta ◽  
Vivek Patel ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Subcutaneous Tissue ◽  
Skin Incision ◽  
Total Blood Loss ◽  
Postoperative Blood Loss ◽  
Total Blood ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> Several techniques are available to minimize the likelihood of blood transfusion following total knee arthroplasty. Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip and total knee arthroplasties with or without cement. The objective of this study was to assess the efficacy of antifibrinolytic treatment along with other measures like saline adrenaline infusion, no drain, no tourniquet and hypotensive anaesthesia in reducing perioperative blood loss during total knee replacement<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Between January 2011 to January 2016,  seventy five consecutive patients who had given written informed consent, undergoing a TKR received tranexamic acid 15 mg/kg body weight intravenous 5 minutes before the skin incision and two doses afterwards (3 and 6 hours after the first dose respectively). TKR was performed in a routine fashion without tourniquet. The saline adrenaline (1:200000) was infiltrated into the skin subcutaneous tissue and capsule before skin incision. A routine closure was carried out without drain. Total blood loss including the hidden blood loss was calculated. All patients were monitored for anemia and postoperative thromboembolic complications.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average total blood loss in study group is 433 ± 148 ml. This is much lesser than what other studies have reported. Mean reduction in hemoglobin levels (gm/dl) between preoperative and postoperative readings is 1.6 gm/dl. One patient had a postoperative DVT which was treated with rivaroxaban 20 mg OD for 6 weeks (oral anticoagulant)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Antifibrinolytic agents like tranexamic acid used along with other measures reported in this study produces a significant decrease in blood loss in patients undergoing total knee replacement<span lang="EN-IN">.</span></p>

scholarly journals Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024350 ◽  
Author(s):  
Qi Sun ◽  
Jinyu Li ◽  
Jiang Chen ◽  
Chenying Zheng ◽  
Chuyin Liu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Total Blood Loss ◽  
Controlled Trials ◽  
Transfusion Rate ◽  
Total Blood ◽  
Total Knee ◽  
Randomised Controlled ◽  
Blood Loss Volume

ObjectiveThis study aimed to compare the effects of intravenous, topical and combined routes of tranexamic acid (TXA) administration on blood loss and transfusion requirements in patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA).DesignThis was a meta-analysis of randomised controlled trials (RCT) wherein the weighted mean difference (WMD) and relative risk (RR) were used for data synthesis applied in the random effects model. Stratified analyses based on the surgery type, region, intravenous and topical TXA dose and transfusion protocol were also conducted. The main outcomes included intraoperative and total blood loss volume, transfusion rate, low postoperative haemoglobin (Hb) level and postoperative Hb decline. However, the secondary outcomes included length of hospital stay (LOS) and/or occurrence of venous thromboembolism (VTE).SettingWe searched the PubMed, Embase and Cochrane CENTRAL databases for RCTs that compared different routes of TXA administration.ParticipantsPatients undergoing TKA or THA.InterventionsIntravenous, topical or combined intravenous and topical TXA.ResultsTwenty-six RCTs were selected, and the intravenous route did not differ substantially from the topical route with respect to the total blood loss volume (WMD=30.92, p=0.31), drain blood loss (WMD=−34.53, p=0.50), postoperative Hb levels (WMD=−0.01, p=0.96), Hb decline (WMD=−0.39, p=0.08), LOS (WMD=0.15, p=0.38), transfusion rate (RR=1.08, p=0.75) and VTE occurrence (RR=1.89, p=0.15). Compared with the combined-delivery group, the single-route group had significantly increased total blood loss volume (WMD=198.07, p<0.05), greater Hb decline (WMD=0.56, p<0.05) and higher transfusion rates (RR=2.51, p<0.05). However, no significant difference was noted in the drain blood loss, postoperative Hb levels and VTE events between the two groups. The intravenous and topical routes had comparable efficacy and safety profiles.ConclusionsThe combination of intravenous and topical TXA was relatively more effective in controlling bleeding without increased risk of VTE.

scholarly journals Effect of Tourniquet use on Blood Loss, Pain, Functional Recovery, and Complications in Robot-assisted Total Knee Arthroplasty: A Prospective, Double-blinded, Randomized Controlled Trial

2021 ◽  
Author(s):  
Yahao Lai ◽  
Hong Xu ◽  
Qiang Su ◽  
Xufeng Wan ◽  
Mingcheng Yuan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Blood Loss ◽  
Range Of Motion ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Total Blood Loss ◽  
Robot Assisted ◽  
Total Blood ◽  
Total Knee

Abstract Background: Robot-assisted total knee arthroplasty (TKA) has been largely studied to confirm its advantages in terms of accurate component positioning, microembolus formation, less blood loss and so on, but is currently usually performed under tourniquet due to its longer operative time than conventional TKA. The aim of this study was to estimate the effects of tourniquet use in robot-assisted TKA on blood loss, pain, functional recovery, and complications.Methods: Patients scheduled for robot-assisted TKA were prospectively randomized into a tourniquet or non-tourniquet group (each n = 14). The primary outcome measure was blood loss. The secondary outcome measures were operation time; visual analog scale (VAS) pain scores; time to achieve the first straight-leg raise; swelling of the thigh, knee, and calf; range of motion; Hospital for Special Surgery score; length of stay; and postoperative complications. Results: There was no significant difference in total blood loss between the tourniquet and non-tourniquet groups (738.57 ± 276.158 vs. 866.85 ± 243.422 ml, P = 0.061). The tourniquet group showed significantly lower intraoperative blood loss (P < 0.001), but higher hidden blood loss (P = 0.002). The non-tourniquet group showed better knee range of motion on POD 1-3 (all P < 0.001), less thigh swelling on PODs 2 and 3 (P < 0.05), earlier straight-leg raising (P = 0.044), and shorter length of stay (P = 0.044). Thigh pain VAS score at 1 month after surgery was significantly greater in the tourniquet group (P < 0.001), as was knee pain during activity and at rest on PODs 2-3 (all P < 0.05). The tourniquet group also showed a significantly higher rate of tension blisters (28.8% vs. 7.1%, P = 0.038). Conclusions: Tourniquet use during robot-assisted TKA dose not reduce total blood loss and it appears to increase postoperative pain, aggravate muscle injury, and prolong postoperative recovery.Trial registration: ChiCTR, ChiCTR2100041800. Registered 5 January 2021, http://www.chictr.org.cn/index.aspx

Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

2017 ◽  
Vol 31 (07) ◽  
pp. 654-663 ◽  
Author(s):  
Wen-Li Dai ◽  
Ai-Guo Zhou ◽  
Hua Zhang ◽  
Jian Zhang
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Meta Analysis ◽  
Primary Total Knee Arthroplasty ◽  
Total Blood Loss ◽  
Transfusion Rate ◽  
Thromboembolic Complications ◽  
Total Blood ◽  
Total Knee ◽  
Primary Total Knee

AbstractThe use of tranexamic acid (TXA) during primary total knee arthroplasty (TKA) is well documented. However, considering the potential side effects, including deep vein thrombosis (DVT) and pulmonary embolism (PE), the ideal route of administration remains controversial. Therefore, we performed a meta-analysis to compare the efficacy of topical versus intravenous TXA and explore the most effective regimen in patients undergoing primary TKA. We conducted a systematic literature search in PubMed, Embase, and the Cochrane database through July 2016 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of topical and intravenous TXA in primary TKA. We assessed the risk of bias using the Cochrane Collaboration's tool. We assessed the quality of evidence using the GRADE profiler software. A total of 15 RCTs including 1,240 participants met the inclusion criteria. We found no statistically significant difference between topical and intravenous TXA in terms of transfusion rate (p = 0.75), total blood loss (p = 0.51), total drain output (p = 0.60), maximum hemoglobin drop (p = 0.24), length of stay (p = 0.08), and thromboembolic complications (p = 0.73). Subgroup analyses showed that compared with 1 g topical TXA, 2 g topical TXA was more effective to reduce blood transfusion rate and total blood loss, and did not increase thromboembolic complications. We also found three times intravenous TXA was more effective than one time of intravenous TXA to reduce blood transfusion rate and total blood loss without increasing of thromboembolic complications. Topical TXA had a similar efficacy to intravenous TXA in reducing blood transfusion and blood loss, and did not increase the risk of thromboembolic complications in primary TKA. Besides, the current meta-analysis suggested that three times of intravenous TXA is efficient and safe. We also recommended 2 g topical TXA instead of 1 g topical TXA because it was more efficient to reduce blood transfusion rate and total blood loss and did not increase thromboembolic complications.

Topical Tranexamic Acid in Total Knee Arthroplasty: Does It Augment the Effect of the Intravenous Administration in Patients with Moderate-to-High Risk of Bleeding? A Randomized Clinical Trial

2020 ◽  
Author(s):  
Ahmed A. Abdallah ◽  
Asser A. Sallam ◽  
Mohamed S. Arafa ◽  
Ayman T. Henawy
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Total Blood Loss ◽  
Transfusion Rate ◽  
Total Blood ◽  
Risk Of Bleeding ◽  
Hidden Blood Loss ◽  
Total Knee ◽  
Topical Tranexamic Acid

AbstractThis study aimed to compare the superimposed clinical value of topical tranexamic acid (TXA) application when it is simultaneously combined with intravenous (IV) administration versus the use of either IV TXA alone or IA TXA alone during primary total knee arthroplasty (TKA) in patients with moderate-to-high risk of bleeding. We hypothesized that the combined administration approach will result in a more adequate reduction in the perioperative blood loss and blood transfusion rate. Ninety-four patients undergoing primary TKA were randomly allocated into intra-articular (IA) alone, IV alone, and combined group. We used 2 g of IV TXA in the IV TXA alone and combined groups 10 minutes before tourniquet deflation. However, we applied 1.5 g TXA in 100 mL isotonic saline half topically before arthrotomy closure and half retrogradely after wound closure through the drain. Follow-up period was 6 weeks. The primary outcome measures included the drainage blood volume, total blood loss, hidden blood loss, intraoperative blood loss, and the allogenic transfusion rate. Secondary outcomes included postoperative hemoglobin drop, amount of transfused blood units, thromboembolism, and wound complications. Combined administration of TXA provided significantly better results in terms of blood volume collected by the drain, total blood loss, and hidden blood loss (p < 0.01). Contrarily, the intraoperative blood loss, the allogeneic transfusion rate, and the number of transfused units were similar in all groups (p > 0.05). The subgroup analysis revealed that a combined IA and IV TXA administration significantly reduced the total blood loss in patients with either moderate or high risk of bleeding. Moreover, the degree of hemoglobin drop was significantly lesser with the combined approach. No thromboembolic complications or wound infection occurred. In conclusion, the combined use of topical and IV tranexamic acid resulted in a significant reduction in postoperative blood loss and hemoglobin level following TKA but did not influence the rate of allogeneic blood transfusion. This is a Level I, therapeutic study.

scholarly journals Predicting Factors for Allogeneic Blood Transfusion and Excessive Postoperative Blood Loss after Single Low-Dosage Intra-Articular Tranexamic Acid Application in Total Knee Replacement

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Paphon Sa-ngasoongsong ◽  
Siwadol Wongsak ◽  
Noratep Kulachote ◽  
Pongsthorn Chanplakorn ◽  
Patarawan Woratanarat ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Postoperative Blood Loss ◽  
Total Blood ◽  
Predicting Factors ◽  
Total Knee ◽  
Low Bmi

Background.Recently, intra-articular tranexamic acid (IA-TXA) application has become a popular method for perioperative blood loss (PBL) reduction in total knee replacement (TKR). Nevertheless, through our knowledge, no previous studies had shown the correlation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT) after IA-TXA.Materials and Methods.A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period (2013-2014). Patient’s characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss (THL), estimated total blood loss (ETBL), and drainage volume per kg (DV/kg). Excessive PBL was defined as PBL that exceeded 90th percentile.Results. From multivariate analysis, low preoperative hemoglobin (Hb) level and body mass index (BMI) were the significant predictors of postoperative BT (p<0.0001and 0.003, resp.). Excessive THL significant associated with preoperative Hb (p<0.0001). Excessive ETBL significantly associated with preoperative Hb, height, preoperative range-of-motion, and creatinine clearance (p<0.05all). Low BMI and large prosthesis size were the significant predictors of excessive DV/kg (p=0.0001and 0.002, resp.).Conclusions. Low preoperative Hb and BMI were the significant risks of postoperative transfusion after TKR with IA-TXA. Moreover, multiple perioperative factors could result in higher PBL.

scholarly journals Comparison of Blood Loss using Intra-Articular Injection of Tranexamic Acid after Total Knee Replacement

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Aziz Sabbir Husain
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Transfusion Rate ◽  
Total Knee

Introduction:  Total knee replacement (TKR) is one of the most common surgeries in orthopedic field. Up to 1/3 of the patients require blood transfusion postoperative. Allogenic transfusion has many side effects. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent. We explore the usage of TXA in reducing blood loss and transfusion rate by injecting it into the knee joint during surgery.  Materials and method: This is a retrospective study done in Hospital Tengku Ampuan Rahimah, Klang. Medical records of patient undergoing TKR between 1 January 2018 till 31 December 2018 were reviewed. Study sample was calculated as 90 patients and divided into 2 groups, one receiving TXA (study) and the other not receiving TXA (control). Post-operative hemoglobin levels and transfusion rate was recorded.  Results: 45 patients in study group (17 male, 28 female) had a mean age of 65.4 years old and 45 patients in control group (24 male, 21 female) had a mean age of 64.2 years old. Mean post-operative hemoglobin drop in study group was 1.08 g/dL vs 1.86 g/dL in control group. Repeated measure ANOVA determined a p value of 0.001 which shows a significant correlation. Total transfusion rate in study group was 1 vs 9 in the control group. Using chi-square test, the p-value was 0.007 which again shows a statistically significant result.  Conclusion: Intra-articular injection of TXA following TKR reduces blood loss and the need for blood transfusion without increasing any complication. This prevents many patients from undergoing a potentially hazardous blood transfusion. A routine usage of intra-articular TXA in patients undergoing TKR is recommended. However a large and well designed RCT is required to investigate the risk and benefits of TXA.

Effect of Tourniquet upon Development of Intra- and Postoperative Complications in Total Knee Replacement in Patients Treated with Pradaxa

2011 ◽  
Vol 18 (4) ◽  
pp. 42-44
Author(s):  
Mikhail Vladimirovich Girkalo ◽  
D M Puchin'yan ◽  
O Yu Voskresenskiy ◽  
A V Derevyanov ◽  
A V Mandrov ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Anticoagulant Therapy ◽  
Early Postoperative Period ◽  
Postoperative Blood Loss ◽  
Thromboembolic Complications ◽  
Total Blood ◽  
Pneumatic Tourniquet ◽  
Total Knee

Results of comparative study of intra- and postoperative blood loss, rate of thromboembolic complications at total knee replacement with and without tourniquet application on the background of anticoagulant therapy with Pradaxa. It was shown that application of pneumatic tourniquet considerably decreased blood loss during the most laborious steps of operation but did not decreased the total blood loss and simultaneously increased the risk of thromboembolic complications development in the early postoperative period. Anticoagulant therapy including oral Pradaxa 220mg/day provided the convenience for the patient to continue thromboprophylaxis after discharge that greatly increased its efficacy.

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