Intra-articular injection of tranexamic acid to reduce blood loss after total knee arthroplasty (original) (raw)
Related papers
International Journal of Orthopaedics, 2019
Total knee arthroplasty (TKA) is associated with significant postoperative blood loss necessitating blood transfusion. Tranexamic acid is an antifibrinolytic drug that has shown good efficacy in reducing this postoperative morbidity. Although, the most commonly used route of administration is intravenous; the optimal route of administration has not been agreed upon. AIM: The aim of this study was to evaluate and compare the efficacy and safety of intravenous and intra-articular administration of tranexamic acid in reducing blood loss following TKA. METHOD: The study was a prospective, interventional; randomized controlled study involving 63 patients who underwent unilateral uncomplicated TKA for severe osteoarthritis of the knee at the National Orthopaedic Hospital, Dala – Kano, Nigeria. The patients were randomized into 3 groups using online random team generator; (1) Intravenous group, (2) Intraarticular group and (3) Control group. RESULTS: The postoperative blood loss was significantly greater in the control group than in intravenous and intraarticular groups (p = 0.02). Also, the postoperative fall in Hb level and the need for blood transfusion were significantly higher in the control group than in intravenous and intraarticular groups (0.00). However, Intravenous and Intraarticular groups did not differ significantly in terms of the measured variables. There was no significant difference between the preoperative and postoperative platelet counts (p = 0.81), INR (p = 0.21) and serum creatinine (p = 0.39) in all the three study groups. CONCLUSION: Intravenous and intraarticular tranexamic acid were equally effective and safe for reducing blood loss after TKA. Key words: Intravenous; Intraarticular; Tranexamic acid; Total knee arthroplasty; Blood loss
2014
Concurrent bilateral total knee arthroplasty (BTKA) would be expected to be associated with a higher blood loss and transfusion requirement. In a previous study utilising intravenous TA, we demonstrated a modest reduction in transfusion requirement with the higher of two recommended doses of intravenous TA 10. However there is an associated risk of systemic thromboembolic events such as deep vein thrombosis (DVT) and pulmonary e m b o l u s (P E) w i t h i n t r a v e n o u s administration. As minimal systemic absorption of TA has been observed with local application (5), we studied the effect of intra-articular TA on blood loss in one knee of patients undergoing BTKA, the other knee of the patient acting as his/her own control. A single surgeon performed all operations utilising the same surgical technique and prosthesis. Introduction Tranexamic acid (TA) is a synthetic amino acid that inhibits fibrinolysis by preventing plasmin binding with fibrinogen and fibrin s t r u c t u re ...
Revista de Gestão e Secretariado (Management and Administrative Professional Review)
Tranexamic acid (TXA) is frequently administered intravenously because it is recognized as a safe and effective procedure. This study's objective is to evaluate the effectiveness of intravenous and intra-articular TXA treatments in patients who have had primary unilateral knee joint replacement. Patients were divided into groups based on TXA applications. Group A patients, those who received intravenous TXA, Group B patients, those who received intraarticular TXA, and Group C patients were intended to serve as the control group. Age, gender, ASA scores, length of hospital stay, preoperative, postoperative, and discharge hemoglobin and hematocrit levels, and the quantity of blood product transfusion given to the patients was analyzed retrospectively. Analysis of the patient’s postoperative Hb values revealed that group C patients had lower Hb values (p < 0.05). Postoperative Hct levels were also seen to be significantly lower in group C individuals (p < 0.05). When the pati...
A study of efficacy of tranexamic acid in reduction of blood loss in primary total knee arthroplasty
International Journal of Research in Orthopaedics, 2018
Background: Tranexamic acid (TXA) has been shown to be effective in reducing blood loss during trauma and surgeries. Although there is no well-established protocol, it is now increasingly being used in joint replacement surgeries. The present study was designed to study the effect of intravenously given tranexamic acid during primary total knee replacement in reducing intraoperative blood loss and need for blood transfusion requirement, compared to a placebo.Methods: This study was designed as a parallel arm, double blind trial. 100 patients of primary osteoarthritis undergoing total knee arthroplasty under tourniquet was included in the study. The efficacy of a single preoperative bolus of TXA in the dose of 15 mg/kg on perioperative blood losses was studied against a placebo with objectives to compare the pre- and 24-hours post-operative level of haemoglobin (Hb) and haematocrit (Hct) levels and assess total volume of blood loss till 24-hours postoperatively and need for blood tra...
Scholars Journal of Applied Medical Sciences
Original Research Article Total Knee Arthroplasty is associated with significant amount of blood loss and may increase the need of blood transfusions. Various blood loss management strategies have been used in the past and Tranexamic Acid is one such commonly used method due to ease of administration and low cost. The use of TXA in primary TKA is associated with reduced transfusion rates, early discharge to home, and reduced economic burden on the patient. Tranexamic Acid can be administered through various routes that include oral, intravenous and intra-articular. However there is no clear consensus on the ideal dosage and route of administration. This study was conducted to compare the effect of intravenous Tranexamic acid with intra-articular Tranexamic acid on post-operative blood loss after unilateral primary total knee arthroplasty (TKA).A total of 58 patients of either gender planned to undergo unilateral total knee replacement (TKR) were enrolled in each of the two groups. In group A (Intra venous Tranexamic acid group) 2 gram intra venous Tranexamic acid was injected. In Group B (Intra-articular Tranexamic acid group), patients were given 2 gram intra-articular Tranexamic acid. All patients were followed up to 72 hours after completion of surgery. Blood collection in negative suction drain was noted after every 24 hours. The mean drainage total blood loss during 72 hours was 637.32±103.53 ml in Group A (intravenous Tranexamic acid)) and 546.35±70.73ml in Group B (Intraarticular Tranexamic acid). The difference was significant in Group A and Group B.Patients who received intraarticular TXA had a lesser drain output (p<0.05) as compared to intravenous administration of Tranexamic Acid. Intra-articular administration of TXA is more effective in reducing postoperative blood loss after primary TKA as compared to intravenous route.
European Journal of Orthopaedic Surgery & Traumatology, 2019
Introduction The effect of tranexamic acid (TXA) on the incidence of venous thromboembolic events (VTEs) in total knee arthroplasty (TKA) as assessed by contrast-enhanced computed tomography (CT) is unclear. Thus, we investigated the efficacy and safety profiles of TXA administration during TKA. We hypothesised that intra-articular 1 g TXA administration would have a sufficient effect on the reduction of blood loss and transfusion rates without increasing VTE risk. Materials and methods We retrospectively analysed 86 patients who underwent primary TKA from January 2014 to September 2017. The study comprised control (n = 45) and TXA (n = 41) groups. All patients underwent navigation-assisted TKA via the medial parapatellar approach. In those who received TXA, 1 g of intra-articular TXA was injected via a drain immediately following wound closure. The drain was clamped for 2 h and then reopened. Contrast-enhanced CT was performed 5-6 days after surgery to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). Blood loss was calculated using the haemoglobin balance method. Results The mean postoperative volume of blood loss was 900 ± 296 mL vs 1216 ± 445 mL in the TXA vs control group (p < 0.01). Allogeneic blood transfusion was required for 0 (0%) vs 6 (13.3%) patients in the TXA vs control group (p = 0.013). There were no significant inter-group differences regarding DVT and PE incidence (p > 0.05). No case of symptomatic PE occurred. Conclusions This study demonstrated that intra-articular 1 g TXA administration during TKA is safe and effective for reducing blood loss and blood transfusion without increasing VTE risk.
Transfusion, 2015
BACKGROUNDTranexamic acid (TXA) has been reported to demonstrate efficacy in reducing blood loss during arthroplasty procedures.STUDY DESIGN AND METHODSThis study examines the effectiveness of TXA as a central element of a patient blood management program (PBMP) by evaluating blood loss and transfusion of red blood cells in three consecutive groups of patients undergoing routine total knee arthroplasty (TKA). Approximately 200 patients were in each group as follows: Group 1 was a control without TXA, Group 2 was intraarticular administration, and Group 3 was intravenous (IV) administration.RESULTSThe IV group demonstrated a small but significant lower blood loss compared to the two other groups measured by hemoglobin (Hb) drift and nadir Hb levels. The routine use of TXA along with the other aspects of our PBMP provided significant cost savings due to the reduction in transfusions as well as a decrease in length of stay and has been an important element of our successful implementat...
The Journal of Arthroplasty, 2014
Tranexamic acid (TA) has been reported to reduce blood loss after total joint arthroplasty; however, the literature is sparse in evaluating its efficacy in simultaneous bilateral total knee arthroplasty (TKA). In this retrospective study of consecutive patients, TA use in bilateral TKA was associated with a significant reduction in perioperative serum hemoglobin drop, as well as allogeneic blood transfusion needs from 50% to 11% of patients. No autologous blood donation or drains were used. There were no venous thromboembolic events reported. Implementation of a systematic intravenous TA protocol in simultaneous bilateral TKA appears highly effective in reducing transfusion requirements, potentially reducing healthcare resource utilization as well as the morbidity and complications associated with allogeneic blood transfusions.
Knee surgery & related research, 2016
Total knee arthroplasty (TKA) accompanies the risk of bleeding and need for transfusion. There are several methods to reduce postoperative blood loss and blood transfusion. One such method is using tranexamic acid during TKA. The purpose of this study was to confirm whether tranexamic acid reduces postoperative blood loss and blood transfusion after TKA. A total of 100 TKA patients were included in the study. The tranexamic acid group consisted of 50 patients who received an intravenous injection of tranexamic acid. The control included 50 patients who received a placebo injection. The amounts of drainage, postoperative hemoglobin, and transfusion were compared between the groups. The mean amount of drainage was lower in the tranexamic acid group (580.6±355.0 mL) than the control group (886.0±375.5 mL). There was a reduction in the transfusion rate in the tranexamic acid group (48%) compared with the control group (64%). The hemoglobin level was higher in the tranexamic acid group t...
Acta orthopaedica et traumatologica turcica, 2016
The aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total knee arthroplasty (TKA). 70 patients (65.5 ± 8.1 years old) that have undergone TKA were divided in two groups. The 20 mg/kg IV TXA was given before the skin incision to one group (study group). On the control group, TKA was performed without TXA. The demographic data, body mass index, amount of bleeding and erythrocyte infusion during the operation, hemoglobin and hematocrit values (preoperative and 48th hour), the amount of drainage after the operation were compared between the groups. The total amount of bleeding in the study group was 634.03 ± 182.88 ml and 1166.42 ± 295.92 ml in the control group (p < 0.001). Perioperative bleeding was 252.01 ± 144.13 ml in the study group and 431.33 ± 209.10 ml in the control group (p = 0.018). The drainage after the operation was 311.11 ± 141.64 ml at the 24th hour in t...