The Safety and Efficacy of Tranexamic Acid in Oncology Patients Undergoing Endoprosthetic Reconstruction and a ROTEM-Based Evaluation of Their Hemostatic Profile: A Pilot Study

Background: An endoprosthetic reconstruction in musculoskeletal oncology patients is associated with significant blood loss. The purpose of this study is to evaluate the safety and efficacy of tranexamic acid (TXA) for these patients and to assess any changes in their hemostatic profile using rotational thromboelastometry (ROTEM). Methods: A retrospective observational study was performed including 61 patients with primary or metastatic bone tumors who underwent surgery. Group A (n = 30) received both intravenous and local TXA whereas Group B (n = 31) was the control group. The primary outcomes were perioperative blood loss and blood unit transfusions and the secondary outcomes included the incidence of thromboembolic complications and a change in blood coagulability as reflected by ROTEM parameters. Results: The median difference in blood loss between the two groups was 548.5 mL, indicating a 29.2% reduction in the 72 h blood loss following TXA administration (p < 0.001). TXA also led to a reduced transfusion of 1 red blood cell (RBC) unit per patient (p < 0.001). The two groups had similar rates of thromboembolic complications (p = 0.99). The antifibrinolytic properties of TXA were confirmed by the significantly higher INTEM, FIBTEM and EXTEM LI60 (p < 0.001, p = 0.005 and p < 0.001, respectively) values in the TXA group. Conclusion: Tranexamic acid was associated with a significant reduction in perioperative blood loss and transfusion requirements without a complete shutdown of the fibrinolysis. Larger studies are warranted to assess the frequency of these outcomes in musculoskeletal oncology patients.

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Effectiveness of tranexamic acid in reducing blood loss in cervical laminoplasty: A retrospective observational study

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720941872 ◽

2020 ◽

Vol 27 (2) ◽

pp. 162-165

Author(s):

Chi-Hei Ho ◽

Raymond Nang-Man Wong

Keyword(s):

Body Mass Index ◽

Blood Loss ◽

Tranexamic Acid ◽

Operating Time ◽

Postoperative Blood Loss ◽

Control Group ◽

Cervical Laminoplasty ◽

Thromboembolic Complications ◽

Perioperative Blood Loss ◽

Control Study

Background: Tranexamic acid (TXA) has been proved effective in reducing perioperative blood loss in patients undergoing orthopedic operations. However, given the heterogeneity in the diagnoses and spinal operations, there are only limited studies comparing patients with uniform diagnoses and procedures performed. Methods: A comparative observational control study was performed on 62 patients with cervical myelopathy. They were divided into control (32) and TXA (30) groups according to whether they had received TXA before and during surgery. Cervical laminoplasty from C3 to C6/7 was performed for all patients using a consistent procedure. Preoperative and postoperative hematological data and perioperative blood loss were compared. Results: There were no statistically significant differences between the two groups in terms of age, gender, body mass index, and operating time. The TXA group had significantly less intraoperative (310 ± 215 ml vs. 144 ± 90 ml, p < 0.05) and postoperative blood loss than the control group (150 ± 50 ml vs. 249 ± 94 ml, p < 0.01). The drop of hemoglobin (Hb) level in the TXA group was also significantly lower (0.5 ± 0.42 g/dl vs. 2.1 ± 1.03 g/dl, p < 0.01). No thromboembolic complications found. Conclusion: TXA significantly reduced perioperative blood loss and reduced drop of postoperative Hb level in cervical laminoplasty.

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Impact of tranexamic acid use on blood loss and transfusion rates following femoral varus derotational osteotomy in children with cerebral palsy

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.180143 ◽

2019 ◽

Vol 13 (2) ◽

pp. 190-195 ◽

Cited By ~ 1

Author(s):

A. Nazareth ◽

S. J. Shymon ◽

L. Andras ◽

R. Y. Goldstein ◽

R. M. Kay

Keyword(s):

Cerebral Palsy ◽

Blood Loss ◽

Tranexamic Acid ◽

Thromboembolic Complications ◽

Safety And Efficacy ◽

Estimated Blood Loss ◽

Transfusion Requirements ◽

Derotational Osteotomy ◽

Venous Thromboembolic Events ◽

Children With Cerebral Palsy

Purpose Previous studies have established the safety and efficacy of tranexamic acid (TXA) in reducing blood loss after total joint arthroplasty and spinal fusion surgery; however, literature regarding the effectiveness of intraoperative TXA in children with cerebral palsy (CP) is limited. The aim of this study was to investigate the safety and efficacy of intraoperative TXA in reducing blood loss and transfusion requirements for children with CP undergoing a proximal femoral varus derotational osteotomy (VDRO). Methods This is a retrospective review of 258 children with CP who underwent VDRO performed at the author’s institution between 2004 and 2017. In all, 36 subjects underwent VDRO surgery with administration of intravenous TXA and 222 subjects underwent VDRO without administration of TXA. Outcome measures including blood loss, transfusion requirements and venous thromboembolic events were compared between groups using t-tests and chi-squared tests. Results No significant differences were seen in the rates of transfusion between groups for the entire hospitalization (TXA group: 11.1% versus No TXA group: 19.8%), intraoperatively (TXA: 2.8% versus No TXA: 9.0%) or postoperatively (TXA: 8.3% versus No TXA: 14.4%). Intraoperative estimated blood loss (TXA: 144.4 mL versus No TXA: 159.0 mL) and percentage blood loss (TXA: 8.9% versus No TXA: 9.2%) were similar between groups. No major thromboembolic complications events occurred in either group. Conclusion The use of TXA was not associated with thromboembolic complications in this series of children with CP undergoing VDRO surgery. Though there was a trend toward lower rates of intraoperative and postoperative blood transfusion with TXA use in these patients, the differences were not significant, possibly due to low estimated blood loss in both groups and sample size. Level of evidence III- retrospective comparative study

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The effectiveness of tranexamic acid on operative and perioperative blood loss in long-segment spinal fusions: a consecutive series of 119 primary procedures

Journal of Neurosurgery Spine ◽

10.3171/2019.11.spine191174 ◽

2020 ◽

Vol 32 (5) ◽

pp. 768-774 ◽

Cited By ~ 2

Author(s):

Mark N. Pernik ◽

Luke J. Dosselman ◽

Salah G. Aoun ◽

Adrienne D. Walker ◽

Kristen Hall ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Control Group ◽

Consecutive Series ◽

Fusion Surgery ◽

Perioperative Morbidity ◽

Spinal Fusion Surgery ◽

Perioperative Blood Loss ◽

Transfusion Requirements ◽

Significant Difference

OBJECTIVEThe aim of this study was to determine if the use of tranexamic acid (TXA) in long-segment spinal fusion surgery can help reduce perioperative blood loss, transfusion requirements, and morbidity.METHODSIn this retrospective single-center study, the authors included 119 consecutive patients who underwent thoracolumbar fusion spanning at least 4 spinal levels from October 2016 to February 2019. Blood loss, transfusion requirements, perioperative morbidity, and adverse thrombotic events were compared between a cohort receiving intravenous TXA and a control group that did not.RESULTSThere was no significant difference in any measure of intraoperative blood loss (1514.3 vs 1209.1 mL, p = 0.29) or transfusion requirement volume between the TXA and control groups despite a higher number of pelvic fusion procedures in the TXA group (85.9% vs 62.5%, p = 0.003). Postoperative transfusion volume was significantly lower in TXA patients (954 vs 572 mL, p = 0.01). There was no difference in the incidence of thrombotic complications between the groups.CONCLUSIONSTXA appears to provide a protective effect against blood loss in long-segment spine fusion surgery specifically when pelvic dissection and fixation is performed. TXA also seems to decrease postoperative transfusion requirements without increasing the risk of adverse thrombotic events.

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Tranexamic Acid has no Effect on Post-Operative Hemarthrosis or Pain Control Following ACL Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blind Randomized Controlled Double-Blind Trial (169)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00291 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0029

Author(s):

Jordan Fried ◽

David Bloom ◽

Samuel Baron ◽

Eoghan Hurley ◽

Jovan Popovic ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Acl Reconstruction ◽

Control Group ◽

Patella Tendon ◽

Double Blind ◽

Randomized Controlled ◽

Perioperative Blood Loss ◽

Significant Difference ◽

Experimental Group

Objectives: Tranexamic acid (TXA) is a commonly used medication in orthopaedic procedures, reducing perioperative bleeding and need for transfusion. The purpose of this double-blind randomized controlled study was to evaluate if IV TXA for primary anterior cruciate ligament (ACL) reconstruction with bone-patella tendon-bone (BTB) could reduce perioperative blood loss or postoperative intra-articular hemarthrosis without postoperative drains. Methods: A controlled, randomized, double-blinded trial was conducted in 110 patients who underwent ACLR with BTB autograft. Patients were equally randomized to the control and experimental groups. The experimental group received two 1-gram boluses of IV TXA, one prior to tourniquet inflation and one prior to wound closure; the control group did not receive TXA. If a clinically significant hemarthrosis was evident, the knee was aspirated, and the volume of blood (ml) was recorded. Additionally, perioperative blood loss (ml); Visual Analog Scale (VAS) on postoperative days (POD) 1-7 and post-operative weeks (POW) 1, 6 and 12; postoperative opioid consumption POD 1-7; range of motion (ROM) and ability to straight leg raise (SLR) at POW 1, 6, 12; and pre and postoperative thigh circumference ratio (TCR). Results: There was no significant difference in perioperative blood loss between the experimental and control groups (32.5ml v. 35.6ml, p=0.47). The experimental group had 23 knees aspirated; control group had 26 knees aspirated (p=0.56). No significant difference seen in postoperative hemarthrosis volume with IV TXA (26.7ml v. 37.3ml, p=0.12). There was no significant difference in VAS score between the two groups (p=0.15), additionally, there was no difference in postoperative opioid consumption (p=0.33). There was no significant difference in ROM or ability to SLR, or pre- nor post-operative TCR (p > 0.05 for all). Conclusions: IV TXA in patients who undergo ACLR with BTB autograft does not significantly impact perioperative blood loss, postoperative hemarthrosis, or postoperative pain levels. Additionally, no significant differences were seen in early post-operative recovery regarding ROM or quadriceps reactivation.

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1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab259.1057 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Varma ◽

R Donovan ◽

M Whitehouse ◽

S Kunutsor ◽

A Blom

Keyword(s):

Systematic Review ◽

Blood Transfusion ◽

Length Of Stay ◽

Blood Loss ◽

Tranexamic Acid ◽

Meta Analysis ◽

Postoperative Blood Loss ◽

Perioperative Blood Loss ◽

Transfusion Requirements ◽

Elbow Replacement

Abstract Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER). We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications. Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay. This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.

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Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

10.21203/rs.2.21728/v2 ◽

2020 ◽

Author(s):

Huiping Wei ◽

Qiuping Xiao ◽

Jianfeng He ◽

Tianji Huang ◽

Wantang Xu ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Elderly Patients ◽

Tranexamic Acid ◽

Topical Application ◽

Control Group ◽

Specific Method ◽

Intertrochanteric Fractures ◽

Perioperative Blood Loss ◽

Perioperative Bleeding

Abstract Background: The specific method and dose of tranexamic acid (TXA) topically applied for intertrochanteric fractures have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically administered via our protocol for perioperative bleeding management in elderly patients with intertrochanteric fractures who underwent proximal femoral nail anti-rotation (PFNA).Methods: A retrospective comparative analysis was performed. The TXA group was composed of 82 patients with topical use of TXA, and the control group was composed of 82 patients without TXA use during the PFNA procedure. Intraoperative, total and hidden amounts of blood loss, drainage volumes, postoperative blood transfusion volumes and complications were compared between the two groups.Results: The intraoperative, total and hidden amounts of blood loss and the drainage volumes were significantly lower in the TXA group than in the control group (P=0.012, P<0.01, P<0.01, P=0.014, respectively). The volume and rate of blood transfusion in the TXA group were significantly lower than those in the control group (P<0.01). There were no significant differences in complications between the two groups (P>0.05).Conclusion: Topical application of TXA offers an effective and safe option for reducing perioperative blood loss and transfusion in elderly patients with intertrochanteric fractures undergoing PFNA.

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Comparison of Efficacy of High versus Low Dose Tranexamic Acid in Reducing, Perioperative Blood Loss and Transfusion Requirements, in Adolescent Idiopathic Scoliosis - An Analytical Study from Retrospective Data Evaluation

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/320 ◽

2020 ◽

Vol 7 (31) ◽

pp. 1521-1525

Author(s):

Ashok Ramakrishnan ◽

Dhanya Vijayan ◽

Jayakumar Christudas

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Tranexamic Acid ◽

Analytical Study ◽

Low Dose ◽

Data Evaluation ◽

Retrospective Data ◽

Perioperative Blood Loss ◽

Transfusion Requirements

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Is There a Role for Preoperative Local Infiltration of Tranexamic Acid in Elective Spine Surgery? A Prospective Randomized Controlled Trial Analyzing the Efficacy of Intravenous, Local Infiltration, and Topical Administration of Tranexamic Acid

Global Spine Journal ◽

10.1177/2192568219888446 ◽

2019 ◽

Vol 11 (1) ◽

pp. 21-27 ◽

Cited By ~ 1

Author(s):

Viswanadha Arun-Kumar ◽

J. Naresh-Babu

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Spine Surgery ◽

Postoperative Blood Loss ◽

Control Group ◽

Intraoperative Blood Loss ◽

Local Infiltration ◽

Safety And Efficacy ◽

Instrumented Spine Surgery

Study Design: Randomized control trial. Objective: The purpose of the study is to evaluate the safety and efficacy of tranexamic acid in reducing blood loss when administered through various routes in instrumented spine surgeries. Methods: A total of 104 patients undergoing instrumented spine surgery were randomly assigned to 4 groups (n = 26 in each group). Groups included (1) ivTXA—intravenous administration of tranexamic acid (TXA) 1 hour prior to surgery, (2) loTXA—local infiltration of TXA bilaterally into the paraspinal musculature prior to incision, (3) tTXA—topical application of TXA just before wound closure, and (4) control group. Outcome measures included intraoperative blood loss, postoperative blood loss, need for blood transfusion, length of hospital stay, and hematological parameters. Results: All the 3 different modes of TXA administration were found to be effective in reducing blood loss in the treated groups compared with the control group. Intraoperative blood loss was significantly reduced in ivTXA (223.6 ± 40.1 mL, P < .0001) and loTXA (256.07 ± 119 mL, P = .0039) groups when compared with controls (344 ± 88.5 mL).The postoperative blood loss was least in tTXA followed by ivTXA, loTXA, and controls. There was 67% reduction in need for blood transfusion in tTXA group, 55.5% reduction in ivTXA group, and 33% reduction in loTXA group when compared with the control group. Conclusion: In instrumented spine surgery, ivTXA and loTXA were found to be equally effective in reducing the intraoperative blood loss. The tTXA has better postoperative blood conserving effects. This is the first study to detail about safety and efficacy on local infiltration of TXA in spine surgery, which is an effective and safe method for reducing intraoperative blood loss.

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Intravenous tranexamic acid reduces blood loss and transfusion requirements after periacetabular osteotomy

The Bone & Joint Journal ◽

10.1302/0301-620x.102b9.bjj-2019-1777.r1 ◽

2020 ◽

Vol 102-B (9) ◽

pp. 1151-1157

Author(s):

Ashley E. Levack ◽

Alexander S. McLawhorn ◽

Emily Dodwell ◽

Kathryn DelPizzo ◽

Joseph Nguyen ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Periacetabular Osteotomy ◽

Operating Time ◽

Intervention Group ◽

Control Group ◽

Double Blind ◽

Arterial Blood ◽

Allogenic Transfusion ◽

Transfusion Requirements

Aims Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion requirements in patients undergoing orthopaedic surgery. There remains a lack of prospective evidence for the use of TXA in patients undergoing periacetabular osteotomy (PAO). The purpose of this study was to determine if intravenous (IV) TXA is effective in reducing calculated blood loss and transfusions after PAO. Methods This was a single-centre prospective double-blind placebo-controlled randomized trial of 81 patients aged 12 to 45 years undergoing elective PAO by a single surgeon. The intervention group (n = 40) received two doses of IV TXA of a maximum 1 g in each dose; the control group (n = 41) received two doses of 50 ml 0.9% saline IV. The primary outcome was perioperative calculated blood loss. Secondary outcomes included allogenic transfusions and six-week postoperative complications. Results There were no differences in demographics or intraoperative variables between study groups. The TXA group demonstrated lower mean calculated blood loss (1,265 ml, (SD 321) vs 1,515 ml, (SD 394); p = 0.002) and lower frequency of allogenic transfusion (10%/n = 4 vs 37%/n = 15; p = 0.008). Regression analyses associated TXA use with significant reductions in calculated blood loss (p < 0.001) and transfusion (p = 0.007) after adjusting for age, sex, body mass index, preoperative haemoglobin, cell-saver volume, intraoperative mean arterial blood pressure, and operating time. No patients suffered venous thromboembolic complications. Conclusion In this trial, IV TXA decreased postoperative calculated blood loss by 293 ml and reduced the frequency of allogenic transfusions by 73% (37% vs 10%) following PAO. TXA may be safe and effective for reducing blood loss in patients undergoing PAO. Cite this article: Bone Joint J 2020;102-B(9):1151–1157.

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Evaluation of tranexamic acid in reducing blood loss and transfusions in total knee replacement

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193832 ◽

2019 ◽

Vol 5 (5) ◽

pp. 899

Author(s):

Mirza Atif Baig ◽

Srujith Kommera

Keyword(s):

Blood Loss ◽

Total Knee Replacement ◽

Tranexamic Acid ◽

Knee Replacement ◽

Acid Group ◽

Control Group ◽

Blood Transfusions ◽

Reduce Blood Loss ◽

Transfusion Requirements ◽

Total Knee

Background: Total knee replacement (TKR) is associated with substantial blood loss and thus the need for blood transfusions. Risks and costs of allogenic blood transfusions requires strategies to reduce blood loss in surgery. The objective of this study was to assess the efficacy of tranexamic acid treatment in reducing blood loss and blood transfusion requirements during TKR.Methods: A randomized controlled trial was conducted on 60 patients who were operated for unilateral TKR from January 2016 to January 2019 in Shadan Institute of Medical Sciences. 30 patients were in each control and study groups. In study group 12 mg/kg bolus of tranexamic acid was given as a slow IV dose, 40 minutes before deflation of tourniquet followed by 1.2 mg/kg/hr infusion for 12 hours with standard treatment of hospital and compared to the control group. Later blood loss was compared both intra and post operatively. Fall in haemoglobin after surgery was also compared.Results: Total blood loss in tranexamic acid group was 543.3±184.85 ml (control group 685.83±176.74 ml) which is statistically significant (p<0.05). Blood loss was markedly decreased in tranexamic acid group (379.16±174 ml in tranexamic acid vs. 513.33±143.89 ml in control group) statistically significant (p<0.05).Conclusions: Tranexamic acid is an effective strategy to reduce blood loss in patients undergoing total knee replacement and thus minimizing the need for blood transfusions.

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