scholarly journals Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial

2021 ◽  
Vol 10 (15) ◽  
pp. 3272
Author(s):  
Man-Soo Kim ◽  
In-Jun Koh ◽  
Yong-Gyu Sung ◽  
Dong-Chul Park ◽  
Won-Jun Ha ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
High Tibial Osteotomy ◽  
Total Blood Loss ◽  
Wound Complications ◽  
Control Group ◽  
Transfusion Rate ◽  
Tibial Osteotomy ◽  
Total Blood ◽  
Wedge High Tibial Osteotomy

(1) Background: the purpose of this study was to investigate the efficacy and safety of intravenous (IV) administration of tranexamic acid (TXA) in patients undergoing medial opening wedge high tibial osteotomy (MOWHTO). (2) Methods: a total of 73 patients were randomly allocated into two groups (TXA group and control group). The primary outcome was total perioperative calculated blood loss after MOWHTO. Secondary outcomes included self-reported pain severity using a 10-point visual analog scale (VAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire. The postoperative allogeneic transfusion rate and wound complications were compared. Deep vein thrombosis (DVT) incidence was compared by conducting DVT computed tomography imaging. (3) Results: the total blood loss after surgery was 470.9 mL in the TXA group and 739.3 mL in the control group, showing a significant difference (p < 0.001). There were no differences in pain VAS scores between the two groups (all p > 0.05). No difference in preoperative EQ-5D scores for any items existed between the two groups. No transfusion was performed in either group. There was no difference in DVT incidence or the rate of wound complications between the two groups. (4) Conclusion: in patients undergoing MOWHTO, IV TXA reduces total blood loss and drainage amount. However, no additional benefits in clinical outcomes, transfusion rate, or wound complications were apparent, with similar DVT incidence rates.

scholarly journals Does the correction angle affect hidden blood loss in HTO?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zheng Li ◽  
Yannong Wang ◽  
Guanglei Cao ◽  
Shuai An ◽  
Mingli Feng ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Blood Loss ◽  
High Tibial Osteotomy ◽  
Total Blood Loss ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Total Blood ◽  
Correction Angle ◽  
Hidden Blood Loss ◽  
Wedge High Tibial Osteotomy

Abstract Background High tibial osteotomy (HTO) has a history of nearly 60 years and has been widely used in clinical practice. Biplanar open wedge high tibial osteotomy (BOWHTO), which evolved from HTO, is an important therapy for the knee osteoarthritis. In our previous research, we found that the decrease of hemoglobin levels after high tibial osteotomy ranges from between 17 to 41 g/L, but this is highly inconsistent with the intraoperative bleeding and postoperative drainage observed in clinical practice. The purpose of this study was to investigate the perioperative hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO), as well as to study the effect of the actual correction angle on blood loss. Methods A retrospective analysis was performed on 21 patients who underwent BOWHTO for osteoarthritis of the knee due to proximal tibia deformity. Gross equation was used to calculate the perioperative total blood loss (TBL) and HBL. The actual correction angle was measured by postoperative anteroposterior radiograph. The correlation between HBL and correction angle was determined through correlation analysis. Results The TBL was 823.5 ± 348.7 mL and the HBL was 601.6 ± 297.3 mL, total hemoglobin loss was 25.0 ± 10.7 g/L, and the mean HBL/patient’s blood volume (H/P) was 13.19 ± 5.56% for 21 patients. The correlation coefficient of correction angle and H/P is statistically significant (|r| = 0.678, P = 0.001). Conclusions The actual total blood loss after BOWHTO was significantly higher than the observed, and the HBL was objective existent after BOWHTO. The proportion of H/P is positively correlated with the correction angle.

Efficacy of repeated intravenous tranexamic acid in reducing perioperative bleeding of acetabular fractures

2021 ◽  
pp. 1-7
Author(s):  
Chen Xu ◽  
Min Wu ◽  
Zhaodong Wang ◽  
Yajun Liu ◽  
Pinghui Zhou ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Operative Time ◽  
Total Blood Loss ◽  
Postoperative Blood Loss ◽  
Acetabular Fractures ◽  
Control Group ◽  
Transfusion Rate ◽  
Total Blood ◽  
Thrombosis Rate

BACKGROUND: Application of tranexamic acid (TXA) in the treatment of acetabular fractures could reduce intraoperative and postoperative blood loss. OBJECTIVE: To investigate the effect of single and repeated intravenous infusion of TXA on blood loss of acetabular fractures. METHODS: 120 patients with acetabular fractures admitted to our hospital from January 2017 to September 2020 were retrospectively divided into three groups: Patients accepted 1g TXA at preoperative 30 minutes were defined as single TXA group (n = 40); Patients accepted 1g TXA at preoperative 30 minutes and 1g TXA at 3 hours after the start of surgery were defined as repeated TXA group (n = 40); Patients accepted normal saline at preoperative 30 minutes were defined as control group (n = 40). RESULTS: The total blood loss in single TXA group and repeated TXA group were significantly lower than control group, and the total blood loss in the repeated TXA group was significantly lower than single TXA group (P <  0.05). The hidden blood loss from surgery to postoperative 1 day in repeated TXA group was significantly lower than single TXA group and the control group(P <  0.05). No significant differences were observed in the operative time, postoperative transfusion rate and thrombosis rate among the three groups (P >  0.05). CONCLUSION: Repeated TXA is more recommended during acetabular fracture surgery since it can reduce the total blood loss without increasing the operative time, postoperative transfusion rate and thrombosis rate compared with single TXA.

scholarly journals The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jimin Ma ◽  
Hanli Lu ◽  
Xinxing Chen ◽  
Dasai Wang ◽  
Qiang Wang
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Meta Analysis ◽  
Total Blood Loss ◽  
Wound Complications ◽  
Transfusion Rate ◽  
Tibial Osteotomy ◽  
Thromboembolic Events ◽  
Efficacy And Safety ◽  
Total Blood

Abstract Objective The present meta-analysis was conducted to evaluate the efficacy and safety of the application of tranexamic acid (TXA) in patients undergoing high tibial osteotomy (HTO). Methods PubMed (MEDLINE), EMBASE, and Cochrane Library were systematically searched for relevant literature from inception until 1 February 2021. A combined searching strategy of subject words and random words was adopted. After testing for potential publication bias and/or heterogeneity, we aggregated variables by using the random-effect model. The primary comparison outcome measures were total blood loss, hemoglobin decrease, drain output, wound complications, thrombotic events, and blood transfusion rate of the TXA group versus control. The meta-analysis was performed using the RevMan 5.3 software. Results A total of 5 studies were included involving 532 patients. The results showed that there were significant differences in the two groups concerning total blood loss (95% confidence interval [CI] − 332.74 to − 146.46, P < 0.00001), hemoglobin decrease on postoperative day (POD) 1, 2, and 5 (POD 1 95% CI − 1.34 to − 0.63, P < 0.00001; POD 2 95% CI − 1.07 to − 0.68, P < 0.00001; POD 5 95% CI − 1.46 to − 0.84, P < 0.00001), drain output (POD total 95% CI − 195.86 to − 69.41, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 0.46, 95% CI 0.09 to 2.41, P = 0.36) and blood transfusion rate (RR = 0.25, 95% CI 0.03 to 2.27, P = 0.22). Conclusions This meta-analysis of the available evidence demonstrated that TXA could reduce total blood loss, hemoglobin decrease, drain output, and wound complications without increasing the incidence of thromboembolic events in patients undergoing HTO. But there is no obvious evidence that TXA could reduce blood transfusion rates. Further studies, including more large-scale and well-designed randomized controlled trials, are warranted to assess the efficacy and safety issues of routine TXA use in HTO patients.

scholarly journals Topical versus intravenous tranexamic acid in total knee arthroplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668430 ◽  
Author(s):  
Sanjay Meena ◽  
Francesco Benazzo ◽  
Saumitra Dwivedi ◽  
Matteo Ghiara
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Randomized Clinical Trials ◽  
Total Blood Loss ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
China National Knowledge Infrastructure ◽  
Tourniquet Time ◽  
Total Blood ◽  
Significant Difference

Purpose: The aim of this meta-analysis is to examine the efficacy and safety of intra-articular tranexamic acid (TXA) when compared to intravenous (IV) route. Methods: The literature search was conducted using PubMed, Cochrane Library, MEDLINE, EMBASE and China National Knowledge Infrastructure (CNKI). All randomized controlled trials evaluating the effectiveness of topical route and IV route of TXA administration were included. Results: Eight randomized clinical trials comprising of 857 patients were included in this analysis. We found no statistically significant difference in terms of total blood loss, drain output, transfusion requirement, thromboembolic complication, tourniquet time and surgical duration. Conclusion: Topical TXA has a similar efficacy to IV-TXA in reducing total blood loss, drain output, transfusion rate and haemoglobin drop without any increase in thromboembolic complications.

scholarly journals Multiple Intravenous Tranexamic Acid Doses After Open Wedge-high Tibial Osteotomy(OW-HTO) Further Reduce Perioperative Blood Loss and Drainage Volume: A Retrospective Study

2021 ◽  
Author(s):  
Zhimeng Wang ◽  
Yao Lu ◽  
Lu Liu ◽  
Leilei Song ◽  
Teng Ma ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
High Tibial Osteotomy ◽  
P Value ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Drainage Volume ◽  
Estimated Blood Loss ◽  
Postoperative Drainage ◽  
Wedge High Tibial Osteotomy

Abstract Background Studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in opening wedge high tibial osteotomy(OW-HTO). However, a consensus has not been established regarding the best dosing regimen and timing. In the present study, we aimed to compare three different dosages of intravenous (IV) TXA in OW-HTO.Material and methods A retrospective analysis of the clinical data obtained from patients administered with OW-HTO treatment for knee osteoarthritis from February 2016 to December 2019 was conducted. All operations were performed under general anaesthesia. TXA1 group (18 patients) received 1g of IV TXA administered 15 to 30 minutes pre-operation. TXA2 group (18 patients) received an additional dose of IV TXA (1g) 3 h after incision and the TXA3 group (18 patients) received an additional (third) dose 6 h later(1g). The blood loss and adverse events were compared between the three groups. Functional analysis, quality of life (QoL), and pain assessment were performed based on their corresponding scoring system.Results Baseline data were comparable for all groups. The postoperative drainage volume was calculated for the TXA3 group and the estimated blood loss was significantly reduced (p-value <0.05). The treatment effectively maintained postoperative Hb at a high level (p-value <0.05). In addition, a faster recovery, better QoL, reduced postoperative pain, and no complications were observed in patients belonging to the group TXA3.Conclusion Based on our results, three doses of IV TXA can effectively and safely reduce estimated blood loss and postoperative drainage volume in patients undergoing OW-HTO with additional associated benefits.

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

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.

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.

Efficacy of Tranexamic Acid for Hemostasis in Patients Undergoing High Tibial Osteotomy

2017 ◽  
Vol 31 (01) ◽  
pp. 050-055 ◽  
Author(s):  
Dong Suh ◽  
Bong Kyung ◽  
Seung-Beom Han ◽  
Kuhoang Cheong ◽  
Won Lee
Keyword(s):  
Tranexamic Acid ◽  
High Tibial Osteotomy ◽  
Postoperative Bleeding ◽  
Postoperative Blood Loss ◽  
Wound Complications ◽  
Osteotomy Site ◽  
Control Group ◽  
Tibial Osteotomy ◽  
Drainage Volume ◽  
Additional Surgery

AbstractExtensive bone bleeding and an uncomfortable hematoma can develop due to the opening gap and space during a medial open high tibial osteotomy (HTO). Tranexamic acid (TXA) has been used in various orthopaedic surgeries to reduce bleeding and wound complications. However, no study has investigated the effect of TXA during HTO. Therefore, the purpose of this study is to evaluate the efficacy of TXA in reducing postoperative blood loss in patients undergoing HTO. The hypothesis is that topical TXA administration will reduce postoperative bleeding in patients undergoing medial opening HTO. Topical TXA (2 g in 20 mL saline) was administered at the osteotomy site in patients (n = 15) who underwent medial open HTO from November 2015 to March 2016. Patients (n = 15) who underwent medial open wedge HTO by the same surgeon from October 2014 to October 2015 were enrolled as a control group for comparison. Drainage volumes on postoperative days (PODs) 1, 2, and 3 as well as hemoglobin (Hb) level on PODs 1, 6, and 13 were measured and compared. Mean total postoperative drainage volume was 246 mL in the TXA group and 377 mL in the control group. Mean drainage volume on POD 1 was 138 mL in the TXA group and 277 mL in the control group (p < 0.05). No differences in drainage volume were detected between the groups on POD 2 or 3. Preoperative Hb levels were 13.0 g/dL in the TXA group and 12.9 g/dL in the control group, which decreased to 11.9 g/dL in the TXA group and 11.2 g/dL in the control group on POD 1. These postoperative Hb differences were significant (p < 0.05). Also, Hb levels were 11.7 and 12.0 g/dL in the TXA group and 11.4 and 11.6 g/dL in the control group on PODs 6 and 13, respectively (p > 0.05). An extensive hematoma requiring additional surgery developed in one case in the control group. No wound complications were detected in the TXA group. Topical TXA was effective for reducing postoperative bleeding after medial open HTO. The level of evidence of the study is Level 3.

scholarly journals Combined Use of Intravenous and Topical Tranexamic Acid Efficiently Reduce Blood Loss in Patients Undergoing 2-level lumbar fusion

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. Keywords: Tranexamic acid, Total hip arthroplasty, Blood loss, Combined treatment

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

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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