nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

01.07.2015 | Knee Arthroplasty

Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial

verfasst von: X Aguilera, M. J. Martínez-Zapata, P. Hinarejos, M. Jordán, J. Leal, J. C. González, J. C. Monllau, F. Celaya, A. Rodríguez-Arias, J. A. Fernández, X. Pelfort, L. l. Puig-Verdie

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 7/2015

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Tranexamic acid (TXA) is becoming widely used in orthopedic surgery to reduce blood loss and transfusion requirements, but consensus is lacking regarding the optimal route and dose of administration. The aim of this study was to compare the efficacy and safety of topical and intravenous routes of TXA with routine hemostasis in patients undergoing primary total knee arthroplasty (TKA).

Materials and methods

We performed a randomized, multicenter, parallel, open-label clinical trial in adult patients undergoing primary TKA. Patients were divided into three groups of 50 patients each: Group 1 received 1 g topical TXA, Group 2 received 2 g intravenous TXA, and Group 3 (control group) had routine hemostasis. The primary outcome was total blood loss. Secondary outcomes were hidden blood loss, blood collected in drains, transfusion rate, number of blood units transfused, adverse events, and mortality.

Results

One hundred and fifty patients were included. Total blood loss was 1021.57 (481.09) mL in Group 1, 817.54 (324.82) mL in Group 2 and 1415.72 (595.11) mL in Group 3 (control group). Differences in total blood loss between the TXA groups and the control group were clinically and statistically significant (p < 0.001). In an exploratory analysis differences between the two TXA groups were not statistically significant (p = 0.073) Seventeen patients were transfused. Transfusion requirements were significantly higher in Group 3 (p = 0.005). No significant differences were found between groups regarding adverse events.

Conclusion

We found that 1 g of topical TXA and 2 g of intravenous TXA were both safe strategies and more effective than routine hemostasis to reduce blood loss and transfusion requirements after primary TKA.

Level of evidence

Nur mit Berechtigung zugänglich

Fahmy NR, Patel DG (1981) Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet. J Bone Joint Surg Am 63(3):461–465PubMed

Petäjä J, Myllynen P, Myllylä G, Vahtera E (1987) Fibrinolysis after application of pneumatic tourniquet. Acta Chir Scand 153(11–12):647–651PubMed

Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, Fries D, Görlinger K, Haas T, Imberger G, Jacob M, Lancé M, Llau J, Mallett S, Meier J, Rahe-Meyer N, Samama CM, Smith A, Solomon C, Van der Linden P, Wikkelsø AJ, Wouters P, Wyffels P (2013) Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 30(6):270–382PubMedCrossRef

Goodnough LT, Maniatis A, Earnshaw P, Benoni G, Beris P, Bisbe E, Fergusson DA, Gombotz H, Habler O, Monk TG, Ozier Y, Slappendel R, Szpalski M (2011) Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth 106(1):13–22PubMedCentralPubMedCrossRef

Kelley TC, Tucker KK, Adams MJ, Dalury DF (2014) Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty. Transfusion 54(1):26–30PubMedCrossRef

Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, Fergusson DA, Ker K (2011) Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 19(1):CD001886

Ker K, Beecher D, Roberts I (2013) Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev 23(7):CD010562

Kim TK, Chang CB, Koh IJ (2014) Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 22(8):1849–1858PubMedCrossRef

Yang ZG, Chen WP, Wu LD (2012) Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 94(13):1153–1159PubMedCrossRef

10.

Zhang H, Chen J, Chen F, Que W (2012) The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 20(9):1742–1752PubMedCrossRef

11.

Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV (2013) Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 20(5):300–309PubMedCrossRef

12.

Hedge C, Wasnik S, Kulkarni S, Pradhan S, Shetty V (2013) Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty 28(10):1888–1891CrossRef

13.

Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR (2012) Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 470(9):2605–2612PubMedCentralPubMedCrossRef

14.

Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL (2014) Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty 29(8):1080–1083

15.

Seo JG, Moon YW, Park SH, Kim SM, Ko KR (2013) The comparative efficacies of intra-articular and iv tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(8):1869–1874PubMedCrossRef

16.

Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R (2014) Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial. J Bone Joint Surg Am 96(23):1937–1944PubMedCrossRef

17.

Huang Z, Ma J, Shen B, Pei F (2014) Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 29(12):2342–2346PubMedCrossRef

18.

Soni A, Saini R, Gulati A, Paul R, Bhatty S, Rajoli SR (2014) Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty. J Arthroplasty 29(8):1525–1527PubMedCrossRef

19.

Wind TC, Barfield WR, Moskal JT (2013) The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty. J Arthroplasty 28(7):1080–1083PubMedCrossRef

20.

Nadler SB, Hidalgo JU, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232PubMed

21.

Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S (2001) Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 83(5):702–705PubMedCrossRef

22.

Aguilera X, Martínez-Zapata MJ, Bosch A, Urrutia G, González JC, Jordán M, Gich I, Maymó RM, Martínez N, Monllau JC, Celaya F, Fernández JA (2013) Efficacy and safety of fibrin glue and tranexamic acid to prevent postoperative blood loss in total knee arthroplasty: a randomized controlled clinical trial. J Bone Joint Surg Am 95(22):2001–2007PubMedCrossRef

23.

Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, Syed KA, Muhammad Ovais Hasan S, De Silva Y, Chung F (2010) Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 92(15):2503–2513PubMedCrossRef

24.

Chimento GF, Huff T, Ochsner JL, Meyer M, Brandner L, Babin S (2013) An evaluation of the use of topical tranexamic acid in total knee arthroplasty. J Artroplasty 28(Suppl 1):74–77CrossRef

25.

Gilbody J, Dhotar HS, Perruccio AV, Davey JR (2014) Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty. J Arthroplasty 29(4):681–684PubMedCrossRef

26.

Konig G, Hamlin BR, Waters JH (2013) Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty 28(9):1473–1476PubMedCrossRef

27.

Sarzaeem MM, Razi M, Kazemian G, Moghaddam ME, Rasi AM, Karimi M (2014) Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty. J Arthroplasty 29(8):1521–1524PubMedCrossRef

28.

Alshryda S, Mason J, Vaghela M, Sarda P, Nargol A, Maheswaran S, Tulloch C, Anand S, Logishetty R, Stothart B, Hungin AP (2013) Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement. A randomized controlled trial (TRANX-K). J Bone Joint Surg Am 95(21):1961–1968PubMedCrossRef

29.

Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, Kubo S, Matsumoto T, Matsushita T, Chin T, Iguchi T, Kurosaka M, Kuroda R (2011) Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 35(11):1639–1645PubMedCentralPubMedCrossRef

30.

Sa-Ngasoongsong P, Channoom T, Kawinwonggowit V, Woratanarat P, Chanplakorn P, Wibulpolprasert B, Wongsak S, Udomsubpayakul U, Wechmongkolgorn S, Lekpittaya N (2011) Postoperative blood loss reduction in computer-assisted surgery total knee replacement by low dose intra-articular tranexamic acid injection together with 2-h clamp drain: a prospective triple-blinded randomized controlled trial. Orthop Rev (Pavia) 3(2):e1. doi:10.4081/or.2011.e1232 CrossRef

31.

Martin JG, Cassatt KB, Kincaid-Cinnamon KA, Westendorf DS, Garton AS, Lemke JH (2014) Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplasty 29(5):889–894PubMedCrossRef

32.

Mutsuzaki H, Ikeda K (2012) Intra-articular injection of tranexamic acid via a drain plus rain-clamping to reduce blood loss in cementless total knee arthroplasty. J Orthop Surg Res 7:32. doi:10.1186/1749-799X-7-32 PubMedCentralPubMedCrossRef

33.

Roy SP, Tanki UF, Dutta A, Jain SK, Nagi ON (2012) Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(12):2494–2501PubMedCrossRef

34.

Diamond PT, Conaway MR, Mody SH, Bhirangi K (2006) Influence of haemoglobin levels on inpatient rehabilitation outcomes after total knee arthroplasty. J Arthroplasty 21(5):636–641PubMedCrossRef

Titel: Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial
verfasst von: X Aguilera
M. J. Martínez-Zapata
P. Hinarejos
M. Jordán
J. Leal
J. C. González
J. C. Monllau
F. Celaya
A. Rodríguez-Arias
J. A. Fernández
X. Pelfort
L. l. Puig-Verdie
Publikationsdatum: 01.07.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 7/2015
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2232-8

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2015

The course of the median and radial nerve across the elbow: an anatomic study

Patient-reported outcome assessment after total joint replacement: comparison of questionnaire completion times on paper and tablet computer

Short-term results of the reverse Total Evolutive Shoulder System (TESS) in cuff tear arthropathy and revision arthroplasty cases

Open fixation of acute anterior glenoid rim fractures with bioresorbable pins: analysis of clinical and radiological outcome

Does intraoperative application of leukocyte-poor platelet-rich plasma during arthroscopy for knee degeneration affect postoperative pain, function and quality of life? A 12-month randomized controlled double-blind trial