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Orthopaedic Surgery Aug 2016The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of i.v. tranexamic acid (TXA) in simultaneous bilateral total knee... (Meta-Analysis)
Meta-Analysis Review
The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of i.v. tranexamic acid (TXA) in simultaneous bilateral total knee arthroplasty (TKA). Potentially relevant published reports were identified from the following electronic databases: Medline, PubMed, Embase, ScienceDirect and Cochrane Library. RevMan v5.3was used to pool data. Two randomized controlled trials and four case-control studies met the inclusion criteria. The current meta-analysis identified significant differences between TXA group and control groups in terms of postoperative hemoglobin concentration (P < 0.01), drainage volume (P < 0.01), transfusion rate (P < 0.01) and units transfused (P = 0.006). There were no significant differences in length of stay (P = 0.66), operation time (P = 0.81) or and incidence of adverse effects such as infection (P = 0.42), deep venous thrombosis (DVT) (P = 0.88) and pulmonary embolism (PE) (P = 0.11). Our results show that i.v. administration of TXA in simultaneous bilateral TKA reduces postoperative drops in hemoglobin concentration, drainage volume, and transfusion requirements and does not prolong length of stay or operation time. Moreover, no adverse effects, such as infection, DVT or PE, were associated with TXA.
Topics: Administration, Intravenous; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Humans; Postoperative Complications; Tranexamic Acid; Treatment Outcome
PubMed: 27627710
DOI: 10.1111/os.12256 -
Annals of Palliative Medicine Sep 2020The risk of blood loss differs among subtypes of revision total hip arthroplasty (THA), and different tranexamic acid (TXA) protocols have rarely been studied in those...
BACKGROUND
The risk of blood loss differs among subtypes of revision total hip arthroplasty (THA), and different tranexamic acid (TXA) protocols have rarely been studied in those conditions. The present study aimed to evaluate the efficacy and safety of intravenous and intravenous plus topical TXA in a subtype of revision THA.
METHODS
We retrospectively reviewed 91 patients who underwent unilateral major revision THA from 2010 to 2018. The major revision was defined as a subtype of revision THA, which included concomitant femoral and acetabular components revision, revision for periprosthetic femoral fracture (PFF), and one-stage revision for periprosthetic joint infection (PJI). In the intravenous group, 23 patients received intravenously 1 g of TXA 30 minutes before the incision with the second dose 3 hours later. In the combined group, 20 patients received intravenously 1 g of TXA 30 minutes before the incision with the second dose 3 hours later, and 2 g of TXA was topically injected around the joint capsule when the fascia layer was closed. Forty-eight patients who underwent revision procedures without TXA constituted the control group. Within the three groups, we compared demographic variables, operation-related data, transfusion volume, transfusion rate, calculated blood loss, postoperative drainage volume, and venous thromboembolism (VTE) risk.
RESULTS
Compared with the control group, both intravenous and combined TXA significantly reduced intraoperative transfusion volume (3.43±2.32 vs. 4.68±2.63 units, P=0.044; 2.78±1.91 vs. 4.68±2.63 units, P=0.004; respectively) and total transfusion volume (4.16±2.73 vs. 5.73±3.05 units, P=0.036; 3.50±2.74 vs. 5.73±3.05 units, P=0.005; respectively), and there were significant reductions of postoperative drainage volume (250.87±204.54 vs. 455.73±303.93 mL, P=0.003; 285.00±218.14 vs. 455.73±303.93 mL, P=0.017; respectively) and calculated blood loss (1,322.49±656.13 vs. 1,698.66±728.39 mL, P=0.031; 1,237.13±545.32 vs. 1,698.66±728.39 mL, P=0.012; respectively). One patient had a symptomatic pulmonary embolism, and two patients had calf muscular vein thrombosis in the control group. There were two patients and one patient with calf muscular vein thrombosis in the intravenous group and the combined group, respectively. Perioperative transfusion volume, transfusion rate, and calculated blood loss were comparable between the intravenous group and the combined group.
CONCLUSIONS
Both intravenous TXA and combined TXA significantly reduced perioperative transfusion volume and calculated blood loss in unilateral major revision THA with comparable perioperative transfusion rate and risk of VTE. More researches are required to explore the optimal TXA administration protocol in subtypes of revision THA.
Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Humans; Retrospective Studies; Tranexamic Acid
PubMed: 32921073
DOI: 10.21037/apm-19-372 -
American Journal of Obstetrics and... Jan 2023The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in...
The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in the care of women with postpartum hemorrhage has come at a price. For the anesthetist, having tranexamic acid ampoules close at hand would seem an obvious strategy to facilitate its use during cesarean delivery, an important setting for severe hemorrhage. Tragically, we have identified a number of recent instances of inadvertent intrathecal administration of tranexamic acid instead of local anesthetic for spinal anesthesia. Reported cases of this catastrophic error seem to be increasing. The profound neurotoxicity of tranexamic acid causes rapid-onset convulsions, with mortality of 50%. How can these tragic errors be averted? Drug safety alerts have been issued by the US Food and Drug Administration and the World Health Organization, but that is not enough. We recommend extensive dissemination of information to raise awareness of this potential hazard, and local hospital protocols to ensure that tranexamic acid is stored separately from anesthetic drugs, preferably outside the operating room and with an auxiliary warning label. Implementation of safety strategies on a very large scale will be needed to ensure that the life-saving potential of tranexamic acid is not eclipsed by drug-error mortality.
Topics: Pregnancy; Female; Humans; Tranexamic Acid; Antifibrinolytic Agents; Postpartum Hemorrhage; Cesarean Section; Anesthetics, Local
PubMed: 36279937
DOI: 10.1016/j.ajog.2022.05.072 -
Medicine May 2018Tranexamic acid (TXA) is an antifibrinolytic drug widely used as a blood-sparing technique in total knee arthroplasty (TKA), and it is usually administrated by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tranexamic acid (TXA) is an antifibrinolytic drug widely used as a blood-sparing technique in total knee arthroplasty (TKA), and it is usually administrated by intravenous or intraarticular injection. Recently, the oral form of TXA has been applied in TKA patients. However, there is no final consensus regarding the effectiveness and safety of oral TXA. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of oral TXA versus control for blood loss after TKA.
METHODS
We searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases for relevant studies through August 2017. The mean difference (MD) of total blood loss, hemoglobin (Hb) drop, hematocrit (Hct), drain output, and risk difference (RD) of transfusion rate and thromboembolic complications in the TXA and control groups were pooled throughout the study. The outcomes were pooled by Stata 12.0.
RESULTS
A total of 5 RCTs (608 patients) were included in this study. All the included studies were randomized and the quality of included studies was relatively high. The pooled results indicated that the oral TXA group had significantly less Hb drop (standardized mean difference [SMD], -0.936; 95% confidence intervals [CI], -1.118,-0.754), Hct drop (SMD, -0.693; 95% CI, -1.113, -0.274), and drain output (SMD, -0.793; 95% CI, -0.959, -0.628) than the control group. No statistically significant differences were found in transfusion rate and the incidence of thromboembolic complications between the 2 groups. Total blood loss could not be evaluated for the insufficient date.
CONCLUSIONS
Our meta-analysis suggested that the administration of oral TXA provided significantly better results with respect to Hb drop, Hct drop, and drain output without increasing the transfusion rate and the risk of thromboembolic complications after TKA. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.
Topics: Administration, Oral; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Drainage; Hematocrit; Hemoglobinometry; Humans; Thromboembolism; Tranexamic Acid
PubMed: 29718858
DOI: 10.1097/MD.0000000000010587 -
The Bone & Joint Journal Jun 2019Tranexamic acid (TXA) has been shown to significantly reduce transfusion rates in primary total hip arthroplasties (THAs), but high-quality evidence is limited in the...
AIMS
Tranexamic acid (TXA) has been shown to significantly reduce transfusion rates in primary total hip arthroplasties (THAs), but high-quality evidence is limited in the revision setting. The purpose of the current study was to compare the rate of blood transfusions and symptomatic venous thromboembolic events (VTEs) in a large cohort of revision THAs treated with or without intravenous (IV) TXA.
PATIENTS AND METHODS
We performed a retrospective review of 3264 revision THAs (2645 patients) between 2005 and 2014, of which 1142 procedures received IV TXA (1 g at incision and 1 g at closure). The mean age in the revision group with TXA was 65 years (28 to 95), with 579 female patients (51%). The mean age in the revision group treated without TXA was 67 years (21 to 98), with 1160 female patients (55%). Outcomes analyzed included rates of transfusion and symptomatic VTEs between procedures undertaken with and without TXA. These comparisons were performed for the overall cohort, as well as within cases subcategorized for aseptic or septic aetiologies. A propensity score was developed to minimize bias between groups and utilized age at revision THA, sex, body mass index, American Society of Anesthesiologists (ASA) score, preoperative anticoagulation, and year of surgery.
RESULTS
Tranexamic acid significantly and substantially reduced the rate of blood transfusions after revision THA overall from 54% to 26% (p < 0.001; adjusted relative risk (RR) 1.6; 95% confidence interval (CI) 1.3 to 1.9), with a significant reduction in both aseptic (49% to 18%; p < 0.001) and septic (73% to 53%; p = 0.04) revisions. The rate of VTE was minimal overall, with three events (0.3%) in the TXA group and four events (0.2%) in the non-TXA group. There were no significant differences in VTE rates based on TXA use or aetiology of revision.
CONCLUSION
Intravenous TXA significantly reduced transfusion rates during all-cause revision THAs, including a subgroup analysis of both aseptic and septic cohorts. Adjusted risk using propensity modelling showed no statistical difference in rates of VTEs between either group. Cite this article: 2019;100-B(6 Supple B):104-109.
Topics: Adult; Aged; Aged, 80 and over; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pulmonary Embolism; Reoperation; Retrospective Studies; Tranexamic Acid; Treatment Outcome; Venous Thrombosis; Young Adult
PubMed: 31146563
DOI: 10.1302/0301-620X.101B6.BJJ-2018-1376.R1 -
Medicine Jun 2017This meta-analysis aimed to evaluate the efficiency and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients undergoing total... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This meta-analysis aimed to evaluate the efficiency and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients undergoing total shoulder arthroplasty.
METHODS
A systematic search was performed in Embase (1980-2017.04, embase.com), Medline (1966-2017.04, medline.com), PubMed (1966-2017.04, pubmed.com), ScienceDirect (1985-2017.04, sciencedirect.com), and Web of Science (1950-2017.04, webofknowledge.com). Study which assessed the efficiency and safety of tranexamic acid in total shoulder arthroplasty was selected. Meta-analysis was performed using Stata 11.0 software.
RESULTS
In all, 484 patients from 2 randomized controlled trials (RCTs) and 2 non-RCTs were subjected to meta-analysis. The present meta-analysis demonstrated that there was less total blood loss (mean difference [MD] -172.16, 95% confidence interval [CI] -35.46 to -308.87, P = .01, d = 0.33) and transfusion rate (odds ratio 0.34, 95% CI 0.13 to 0.91, P = .03, d = 0.29) in tranexamic acid groups compared with the control groups. There were no significant differences in duration of surgery (MD 0.02, 95% CI -0.12 to 0.22, P = .89, d = 0.19), length of stay (MD -0.06, 95% CI -0.26 to 0.14, P = .56, d = 0.20), or incidence of adverse effects such as deep venous thrombosis (odds ratio 1.15, 95% CI 0.33 to 4.00, P = .83, d = 0.53).
CONCLUSION
Clinical application of tranexamic acid seemed to result in significant reductions in total blood loss, hemoglobin decline and transfusion requirements following total shoulder arthroplasty. Moreover, no increased risk of the thrombotic events was identified. Due to the limited quality of the evidence currently available, higher quality RCTs are required.
Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Shoulder; Blood Loss, Surgical; Blood Transfusion; Clinical Trials as Topic; Humans; Shoulder; Tranexamic Acid
PubMed: 28562553
DOI: 10.1097/MD.0000000000007015 -
Urology Journal Jul 2021Tranexamic acid is a fibrinolysis suppressor that is used for a variety of bleeding control procedures such as hematuria, surgery bleeding, and trauma caused bleeding.... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Tranexamic acid is a fibrinolysis suppressor that is used for a variety of bleeding control procedures such as hematuria, surgery bleeding, and trauma caused bleeding. The advantages of using the tranexamic acid are bleeding control and less need for blood transfusion.
MATERIALS AND METHODS
This double blind clinical trial was conducted on 108 patients in Imam Khomeni Hospital, Urmia, Iran 2013-14. The control and intervention groups consisted of 54 randomly selected participants each. The intervention group received 1gr of intravenous tranexamic acid with initiation of surgery and 500mg orally each 8hrs afterwards up to three days. The control group received placebo capsules containing starch of the same form.
RESULTS
The mean term of hospitalization in the intervention group was significantly shorter than that of the control group (P<0.001). The difference between the two groups in terms of preoperative hemoglobin was not significant. However, the decrease in postoperative hemoglobin, intraoperative hemoglobin count in washing liquid, and hemoglobin count in the intervention group were significantly different from those of the control group (P<0.001).
CONCLUSION
The findings showed that tranexamic acid decreased bleeding during PCNL and the need for blood transfusion. It also decreased the hospitalization term.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Humans; Nephrolithotomy, Percutaneous; Tranexamic Acid
PubMed: 34291443
DOI: 10.22037/uj.v18i.6505 -
Medicine Mar 2022Tranexamic acid has been increasingly used for blood conservation in cardiac surgery. However, the evidence supporting the routine use of tranexamic acid in Chinese... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Tranexamic acid has been increasingly used for blood conservation in cardiac surgery. However, the evidence supporting the routine use of tranexamic acid in Chinese pediatric patients undergoing cardiac surgery remains weak. This meta-analysis aimed to systematically review the efficacy of tranexamic acid when applying to Chinese pediatric patients undergoing cardiac surgery.
PARTICIPANTS
Chinese pediatric patients undergoing cardiac surgery.
INTERVENTIONS
Tranexamic acid or control drugs (saline/blank).
METHODS
PUBMED, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Data till May 4, 2021, database search was updated on August 1. Primary outcomes of interest included postoperative bleeding, allogeneic transfusion, and reoperation for bleeding. Secondary outcomes of interest included postoperative recovery. For continuous/dichotomous variables, treatment effects were calculated as weighted mean difference (WMD)/odds ratio and 95% confidence interval.
RESULTS
A database search yielded 15 randomized controlled trials including 1641 patients, where 8 studies were allocated into non-cyanotic congenital group, 5 were allocated into cyanotic congenital group, and the other 2 were allocated into combined cyanotic/non-cyanotic group. This meta-analysis demonstrate that tranexamic acid administration can reduce the postoperative 24 hours blood loss in non-cyanotic, cyanotic, and combined cyanotic/non-cyanotic patients, the red blood cell transfusion in non-cyanotic and cyanotic patients, and the fresh frozen plasma transfusion in non-cyanotic and combined cyanotic/non-cyanotic patients.
CONCLUSION
This meta-analysis demonstrates that tranexamic acid is highly effective in reducing the blood loss in Chinese pediatric cardiac surgery, but it behaves poorly when it comes to the transfusion requirement. To further confirm this, more well-designed and adequately-powered randomized trials are needed.
Topics: Antifibrinolytic Agents; Blood Component Transfusion; Blood Loss, Surgical; Cardiac Surgical Procedures; Child; Humans; Pediatrics; Postoperative Hemorrhage; Tranexamic Acid
PubMed: 35244062
DOI: 10.1097/MD.0000000000028966 -
BJOG : An International Journal of... Jan 2023The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in...
The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in the care of women with postpartum hemorrhage has come at a price. For the anesthetist, having tranexamic acid ampoules close at hand would seem an obvious strategy to facilitate its use during cesarean delivery, an important setting for severe hemorrhage. Tragically, we have identified a number of recent instances of inadvertent intrathecal administration of tranexamic acid instead of local anesthetic for spinal anesthesia. Reported cases of this catastrophic error seem to be increasing. The profound neurotoxicity of tranexamic acid causes rapid-onset convulsions, with mortality of 50%. How can these tragic errors be averted? Drug safety alerts have been issued by the US Food and Drug Administration and the World Health Organization, but that is not enough. We recommend extensive dissemination of information to raise awareness of this potential hazard, and local hospital protocols to ensure that tranexamic acid is stored separately from anesthetic drugs, preferably outside the operating room and with an auxiliary warning label. Implementation of safety strategies on a very large scale will be needed to ensure that the life-saving potential of tranexamic acid is not eclipsed by drug-error mortality.
Topics: Pregnancy; Female; Humans; Tranexamic Acid; Antifibrinolytic Agents; Postpartum Hemorrhage; Cesarean Section; Medication Errors
PubMed: 36300729
DOI: 10.1111/1471-0528.17292 -
Anaesthesia Jan 2015There is a considerable difference between the mechanism of action of the lysine analogues, tranexamic acid and epsilon-aminocaproic acid, and the serine protease... (Review)
Review
There is a considerable difference between the mechanism of action of the lysine analogues, tranexamic acid and epsilon-aminocaproic acid, and the serine protease inhibitor aprotinin. Aprotinin acts to inactivate free plasmin, but with little effect on bound plasmin, whereas the lysine analogues are designed to prevent excessive plasmin formation by fitting into plasminogen's lysine-binding site to prevent the binding of plasminogen to fibrin. Aprotinin is associated with a reduction in bleeding and transfusion requirements following major surgery, and has a dose-response profile, compared with no dose-response effect in the one study investigating tranexamic acid in cardiac surgical patients. Following its withdrawal in 2007, which is explained in detail in this review, the regulators have now licensed aprotinin for myocardial revascularisation only, which is relatively low-risk for bleeding.
Topics: Animals; Aprotinin; Hemorrhage; Hemostatics; Humans; Tranexamic Acid
PubMed: 25440394
DOI: 10.1111/anae.12907