Comparison of Two Methods of Bolus and Infusion of Tranexamic Acid in Reduction of Blood Loss in Total Knee Arthroplasty (original) (raw)
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Background: Until today, many studies conduct to determine the optimal dose and regimen of tranexamic acid to reduce the preoperative and postoperative blood loss in primary total knee arthroplasty. In this study, we were compared two different methods of administration (bolus and infusion). Materials and Methods: Forty patients were randomized in two groups; all the patients received 500 mg tranexamic acid before tourniquet was turned on. Group (A) consisted of 20 patients (mean age: 64± 6.1 years) received 500 mg tranexamic acid ten minutes before tourniquet was loosened and group (B) (63.5 ± 7.7 years) received 500 mg tranexamic acid IV infusion during 6 hours from the time of tourniquet loosening (total dose of TA 1 g in both groups). Intraoperative blood loss, postoperative drainage (in 6 and 12 hours), blood transfusion (in 48 hours), hematocrit and hemoglobin decrease (6 and 12 hours later) were compared between two groups. Results: The patients in group (B) had less blood lo...
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...
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...
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...
2019
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 result...
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...
Tranexamic acid for the reduction of blood loss in total knee arthroplasty
Annals of translational medicine, 2015
The Journal of Arthroplasty recently published a paper entitled "The Efficacy of Combined Use of Intraarticular and Intravenous Tranexamic Acid on Reducing Blood Loss and Transfusion Rate in Total Knee Arthroplasty". Tranexamic acid (TXA) is an antifibrinolytic drug whose administration during the perioperative period either by intravenous route or topically applied to the surgical field has been shown to reliably reduce blood loss and need for transfusion in patients undergoing total knee arthroplasty (TKA). Although randomized trials and meta-analyses did not show an increase in thromboembolic events, concerns remain about its repeated systemic application. The authors of the study introduced a novel regimen of TXA administration combining a preoperative intravenous bolus followed by local infiltration at the end of surgery with the idea of maximizing drug concentration at the surgical site while minimizing systemic antifibrinolytic effects. The combined dosage regimen a...
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.
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