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JBJS Reviews Jun 2024The effectiveness of tranexamic acid (TXA) as an antifibrinolytic agent in total shoulder arthroplasty (TSA) is well documented; however, there remains considerable... (Review)
Review
BACKGROUND
The effectiveness of tranexamic acid (TXA) as an antifibrinolytic agent in total shoulder arthroplasty (TSA) is well documented; however, there remains considerable practice variability concerning the optimal route of administration and dosing protocols concerning the medication's use. Our aim was to conduct a scoping review of the literature regarding the efficacy of various methods of TXA administration in TSA and to identify knowledge gaps that may be addressed.
METHODS
A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The PubMed and MEDLINE electronic databases were searched to identify all articles published before March 2023 investigating the administration of TXA in TSA. Randomized controlled trials and cohort studies were included, and data were extracted to capture information regarding intervention details and related outcomes such as blood loss, transfusion needs, and complication rates.
RESULTS
A total of 15 studies were included in this review. All selected studies used either intravenous (IV) or topical TXA, with 1 study also including a combined approach of both topical and IV TXA. Of the studies that used an IV approach, the most commonly reported favorable outcomes were a reduction in blood volume loss, reduction in hemoglobin or hematocrit change, and decreased drain output. Dosing varied significantly between all identified studies because some used a standard dosing amount in grams or milligrams for all treatment group participants, whereas others used weight-based dosing amounts. All studies that used a weight-based dosing regimen as well as studies using a standard dosing amount between 1,000 and 5,000 mg reported favorable outcomes for postoperative blood loss.
CONCLUSION
Both IV and topical TXA clearly demonstrate favorable perioperative hematologic profiles in TSA. Although both approaches have demonstrated a successful association with decreased blood loss and transfusion requirements, there is no definitive benefit to choosing one over the other. Furthermore, the use of oral TXA either in combination or isolation warrants further study in TSA because of its comparable efficacy profiles and significantly lower associated costs of application.
Topics: Tranexamic Acid; Humans; Arthroplasty, Replacement, Shoulder; Antifibrinolytic Agents; Blood Loss, Surgical
PubMed: 38889236
DOI: 10.2106/JBJS.RVW.24.00035 -
Aesthetic Surgery Journal Dec 2023
Topics: Humans; Tranexamic Acid; Postoperative Hemorrhage; Blood Loss, Surgical
PubMed: 37837374
DOI: 10.1093/asj/sjad328 -
ANZ Journal of Surgery Apr 2020
Topics: Antifibrinolytic Agents; Blood Coagulation; Fibrin; Fibrinolysin; Fibrinolysis; Hemorrhage; Humans; Randomized Controlled Trials as Topic; Time Factors; Tranexamic Acid; Wounds and Injuries
PubMed: 32339417
DOI: 10.1111/ans.15541 -
Ugeskrift For Laeger Apr 2016Tranexamic acid inhibits the degradation of a newly formed fibrin clot. The drug reduces blood loss and transfusion requirements in a wide range of different clinical... (Review)
Review
Tranexamic acid inhibits the degradation of a newly formed fibrin clot. The drug reduces blood loss and transfusion requirements in a wide range of different clinical scenarios and patient settings. So far, tranexamic acid is not part of standard treatment among patients with gastrointestinal bleeding. This article evaluates the available literature on this topic. Tranexamic acid seems appropriate as adjuvant treatment during upper gastrointestinal bleeding. However, these patients are often old and have several co-morbidities. Therefore, thromboembolic risk and tranexamic acid dosage should be carefully evaluated.
Topics: Antifibrinolytic Agents; Gastrointestinal Hemorrhage; Humans; Risk Factors; Thromboembolism; Tranexamic Acid
PubMed: 27094539
DOI: No ID Found -
Journal of Medical Toxicology :... Apr 2024
Topics: Humans; Tranexamic Acid; Drug Overdose; Blood Loss, Surgical
PubMed: 38334906
DOI: 10.1007/s13181-024-00989-z -
Journal of the American Academy of... Jan 2022
Topics: Humans; Rosacea; Steroids; Tranexamic Acid
PubMed: 31931084
DOI: 10.1016/j.jaad.2019.12.067 -
The Lancet. Neurology Dec 2020Despite intracerebral haemorrhage causing 5% of deaths worldwide, few evidence-based therapeutic strategies other than stroke unit care exist. Tranexamic acid decreases... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Despite intracerebral haemorrhage causing 5% of deaths worldwide, few evidence-based therapeutic strategies other than stroke unit care exist. Tranexamic acid decreases haemorrhage in conditions such as acute trauma and menorrhoea. We aimed to assess whether tranexamic acid reduces intracerebral haemorrhage growth in patients with acute intracerebral haemorrhage.
METHODS
We did a prospective, double-blind, randomised, placebo-controlled, investigator-led, phase 2 trial at 13 stroke centres in Australia, Finland, and Taiwan. Patients were eligible if they were aged 18 years or older, had an acute intracerebral haemorrhage fulfilling clinical criteria (eg, Glasgow Coma Scale score of >7, intracerebral haemorrhage volume <70 mL, no identified or suspected secondary cause of intracerebral haemorrhage, no thrombotic events within the previous 12 months, no planned surgery in the next 24 h, and no use of anticoagulation), had contrast extravasation on CT angiography (the so-called spot sign), and were treatable within 4·5 h of symptom onset and within 1 h of CT angiography. Patients were randomly assigned (1:1) to receive either 1 g of intravenous tranexamic acid over 10 min followed by 1 g over 8 h or matching placebo, started within 4·5 h of symptom onset. Randomisation was done using a centralised web-based procedure with randomly permuted blocks of varying size. All patients, investigators, and staff involved in patient management were masked to treatment. The primary outcome was intracerebral haemorrhage growth (>33% relative or >6 mL absolute) at 24 h. The primary and safety analyses were done in the intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT01702636).
FINDINGS
Between March 1, 2013, and Aug 13, 2019, we enrolled and randomly assigned 100 participants to the tranexamic acid group (n=50) or the placebo group (n=50). Median age was 71 years (IQR 57-79) and median intracerebral haemorrhage volume was 14·6 mL (7·9-32·7) at baseline. The primary outcome was not different between the two groups: 26 (52%) patients in the placebo group and 22 (44%) in the tranexamic acid group had intracerebral haemorrhage growth (odds ratio [OR] 0·72 [95% CI 0·32-1·59], p=0·41). There was no evidence of a difference in the proportions of patients who died or had thromboembolic complications between the groups: eight (16%) in the placebo group vs 13 (26%) in the tranexamic acid group died and two (4%) vs one (2%) had thromboembolic complications. None of the deaths was considered related to study medication.
INTERPRETATION
Our study does not provide evidence that tranexamic acid prevents intracerebral haemorrhage growth, although the treatment was safe with no increase in thromboembolic complications. Larger trials of tranexamic acid, with simpler recruitment methods and an earlier treatment window, are justified.
FUNDING
National Health and Medical Research Council, Royal Melbourne Hospital Foundation.
Topics: Aged; Aged, 80 and over; Antifibrinolytic Agents; Cerebral Hemorrhage; Double-Blind Method; Female; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Prospective Studies; Tranexamic Acid
PubMed: 33128912
DOI: 10.1016/S1474-4422(20)30369-0 -
The Annals of Pharmacotherapy 2012To review the pharmacology, pharmacokinetics, efficacy, and safety profile of an oral modified-release (MR) formulation of tranexamic acid. (Review)
Review
OBJECTIVE
To review the pharmacology, pharmacokinetics, efficacy, and safety profile of an oral modified-release (MR) formulation of tranexamic acid.
DATA SOURCES
Literature was accessed through MEDLINE (1966-July 2012), Iowa Drug Information Service (1997-July 2012), and bibliographies of pertinent articles. Search terms included tranexamic acid, Lysteda, menorrhagia, menstrual blood loss, and heavy menstrual bleeding.
STUDY SELECTION AND DATA EXTRACTION
All available English-language abstracts and human studies were identified for review. Data provided by the manufacturer and the Food and Drug Administration were also evaluated. Efficacy was evaluated in 2 clinical trials, change in quality of life was evaluated in 3 clinical trials, and safety was evaluated in 4 clinical trials.
DATA SYNTHESIS
Tranexamic acid is a synthetic lysine analogue with antifibrinolytic activity. It interferes with the binding of plasminogen to fibrin, resulting in enhanced fibrin clot integrity. A novel MR formulation of oral tranexamic acid is approved for treatment of cyclic heavy menstrual bleeding. MR tranexamic acid is initiated at the beginning of heavy menstrual bleeding and can be taken for up to 5 days per cycle. Clinical trials show it to be safe and effective. Dosage adjustments are needed for women with renal insufficiency. Adverse effects are considered mild to moderate, with the most common being menstrual discomfort, headache, and back pain. The most significant safety concerns relate to the risk of thromboembolism.
CONCLUSIONS
MR tranexamic acid offers a new first-line therapy for patients with cyclic heavy menstrual bleeding. It is reported to be safe and effective. There are no labeled equivalents to MR tranexamic acid for cyclic heavy menstrual bleeding.
Topics: Administration, Oral; Animals; Antifibrinolytic Agents; Female; Humans; Menorrhagia; Quality of Life; Tranexamic Acid; Treatment Outcome
PubMed: 22811348
DOI: 10.1345/aph.1R025 -
Thrombosis Research May 2017The appropriate route for administering tranexamic acid in primary total hip (THA) and knee arthroplasty (TKA) remains controversial. The purpose of this meta-analysis... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
The appropriate route for administering tranexamic acid in primary total hip (THA) and knee arthroplasty (TKA) remains controversial. The purpose of this meta-analysis was to compare the efficacy and safety of topical or intravenous tranexamic acid.
METHODS
PubMed, EMBASE, and the Cochrane Library databases were systematically searched for randomized controlled trials (RCTs) comparing topical and intravenous tranexamic acid following primary THA or TKA. Primary outcomes were transfusion frequency and maximum drop in hemoglobin. Other parameters included total blood loss (TBL), hidden blood loss, drainage volume, hemoglobin level on postoperative day 1 (POD 1), deep vein thrombosis (DVT), pulmonary embolism (PE), wound complications and other adverse events. Data were analyzed using Rev Man 5.2.
RESULTS
A total of 18 RCTs involving TKA and 4 RCTs involving THA, corresponding to approximately 2260 patients, were included in the meta-analysis. No significant difference between topical and intravenous tranexamic acid was found in transfusion requirement (RR 1.14, 95%CI 0.87 to 1.50, p=0.35). The maximum drop in hemoglobin was significantly smaller in the intravenous group than in the topical group (MD 0.33g/dL, 95%CI 0.07 to 0.58, p=0.01); similar results were observed for the subset of studies involving THA (MD 0.49g/dL, 95%CI 0.28 to 0.70, p<0.001) and the subset involving TKA (MD 0.30g/dL, 95%CI 0.02 to 0.59, p=0.04). The topical and intravenous groups did not differ significantly in TBL, drainage volume, hemoglobin level on POD 1, DVT, PE, wound complications or other adverse events.
CONCLUSION
The available evidence indicates similar transfusion requirements and safety for topical and intravenous tranexamic acid in THA and TKA. However, intravenous injection seems to be associated with a smaller maximum drop in hemoglobin.
Topics: Administration, Intravenous; Administration, Topical; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Humans; Tranexamic Acid
PubMed: 28319822
DOI: 10.1016/j.thromres.2017.03.009 -
Lancet (London, England) Apr 2022
Topics: Antifibrinolytic Agents; Humans; Prejudice; Tranexamic Acid; Wounds and Injuries
PubMed: 35429441
DOI: 10.1016/S0140-6736(22)00664-X