Objective To systematically review the clinical efficiency and safety after topical administration of tranexamic acid in total hip arthroplasty. Methods Relevant randomized controlled trials were identified from databases such as Cochrane Library, PubMed, Embase and CNKI from the establishment of the database to August, 2017. A systematic review was performed to compare total blood loss, the rate of transfusion and thromboembolism events between the tranexamic acid group and the control group. And the patients in tranexamic acid group were treated with tranexamic acid for hemorrhage after total hip arthroplasty, while the patients in the control group were not treated with tranexamic acid or used isotonic saline. Analysis was carried out using Review Manager version 5.2.0 software. Results Eight studies were incorporated into the Meta-analysis. The results of Meta-analysis showed that there was significant difference in total blood loss between two groups [weighted mean difference (WMD)=–360.27 mL, 95% confidence interval (CI) (–412.68, –307.87) mL, P<0.000 01]. There was significant difference in the rate of transfusion between two groups [ (odds ratio,OR)=0.22, 95%CI (0.14, 0.33), P<0.000 01]. There was no significant difference in complications between two groups [OR=1.48, 95%CI (0.41, 5.34), P=0.55]. Conclusion Topical administration of tranexamic acid could significantly reduce total blood loss and transfusion requirements in primary total hip arthroplasty, and would not increase thromboembolic complications.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=−12.07 min, 95%CI (−17.21, −6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=−1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (−3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (−0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.
ObjectiveTo investigate the safety and effectiveness of using tranexamic acid in total knee arthroplasty (TKA). MethodsBetween May 2012 and May 2013, 88 patients (88 knees) with degenerative osteoarthritis underwent primary TKA and were divided into 2 groups (n=44) according to whether use of tranexamic acid (15 mg/kg) or not. Seventy-seven patients (39 in trial group and 38 in control group) were enrolled in this study except 11 patients who failed to be followed up. There was no significant difference in gender, age, disease duration, body mass index, osteoarthritis grading, and preoperative general data of laboratory examination between 2 groups (P > 0.05). The following indexes were recorded and compared between 2 groups: intraoperative tourniquet time, intraoperative blood loss, postoperative drainage volume during 24 hours, total drainage volume, hidden blood loss, total blood loss, the number of transfusion, postoperative haemoglobin (Hb) at 3 days, postoperative D-dimer at 24 hours, ecchymosis, and deep venous thrombosis (DVT). ResultsNo statistically significant difference was found in intraoperative tourniquet time and intraoperative blood loss between 2 groups (P > 0.05). The postoperative drainage volume during 24 hours, total drainage volume, hidden blood loss, total blood loss, and postoperative D-dimer at 24 hours in trial group were significantly lower than those in control group (P < 0.05). The postoperative Hb at 3 days in trial group was significantly higher than that in control group (t=4.815, P=0.000). Three cases (7.7%) of trial group and 4 cases (10.5%) of control group were given blood transfusion, showing no significant difference (P > 0.05); DVT occurred in 3 cases of 2 groups repectively (7.7%, 7.9%), showing no significant difference (P > 0.05). Extremity ecchymosis occurred in 1 case (2.6%) of trial group and in 7 cases (18.4%) of control group, showing significant difference (χ2=0.029, P=0.026). ConclusionUse of tranexamic acid can significantly reduce blood loss and does not increase the risk of DVT after TKA.
ObjectiveTo investigate the safety and effectiveness of low-dose tranexamic acid (TXA) in operation of multi-level continuous thoracic ossification of ligament flavum (TOLF).MethodsA clinical data of 26 patients who underwent operation for multi-level continuous TOLF and met the selection criteria between July 2015 and January 2019 was retrospectively analyzed. Among them, 13 cases (group A) were received intravenous infusion of TXA (10 mg/kg) at 15 minutes before operation, and maintained the infusion at 1 mg/(kg·h) until the end of the operation; 13 cases (group B) were received the same dose of normal saline before and during operation. There was no significant difference in gender, age, body mass index, diseased segment, and preoperative hemoglobin, platelet count, activated partial thromboplastin time, prothrombin time, international normalized ratio (INR) between the two groups (P>0.05). The hemoglobin, platelet count, activated partial thromboplastin time, prothrombin time, INR, the number of deep vein thrombosis of the lower extremities, operation time, intraoperative blood loss, postoperative drainage volume, total blood loss, and the time of drainage tube extubation in the two groups were recorded and compared.ResultsAll operations in the two groups were successfully completed. Compared with group B, the operation time and time of drainage tube extubation in group A were shortened, and the intraoperative blood loss, postoperative drainage volume, and total blood loss were reduced. The differences between the two groups were significant (P<0.05). None of the two groups received blood transfusion, and the hemoglobin level of group A at 24 hours after operation was significantly higher than that of group B (t=5.062, P=0.000). The incisions in both groups healed and sutures were removed within 2 weeks after operation, and no complications occurred. There was no significant difference between the two groups in activated partial thromboplastin time, prothrombin time, INR, and platelet count at 24 hours after operation (P>0.05).ConclusionIn multi-level continuous TOLF operation, intravenous administration of low-dose TXA can effectively reduce blood loss, shorten postoperative drainage time, and does not increase the risk of complications.
Objective To explore the effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release. Methods The clinical data of 44 patients with elbow joint stiffness who were treated with release surgery between March 2022 and December 2023 and met the selection criteria were retrospectively analyzed. Among them, 20 patients were given intravenous infusion of 100 mL (1 g/100 mL, once a day) of tranexamic acid solution for 3 consecutive days after surgery (group A), and 24 patients were not treated with tranexamic acid after surgery (group B). There was no significant difference in baseline data such as gender, age, side, body mass index, initial injury, and preoperative hemoglobin, visual analogue scale (VAS) score, and Mayo elbow function score (MEPS), elbow flexion and extension activity between the two groups (P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, postoperative hospital stay, VAS score before operation and at 1, 2, and 3 days after operation, MEPS score before operation, at 3 months after operation, and at last follow-up, and elbow flexion and extension activity before operation and at last follow-up were recorded and compared between the two groups. Results Both groups of patients successfully completed the operation, and there was no significant difference in operation time (P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, and postoperative hospital stay in group A were significantly less than those in group B (P<0.05). Both groups of patients were followed up 6-12 months, with an average of 8.6 months. No complications such as wound infection, elbow joint varus and varus instability or dislocation, and pulmonary embolism or other thromboembolic events occurred in either group. The VAS scores of both groups were significantly higher at 1 day and 2 days after operation than before operation (P<0.05); the VAS score of group A was significantly lower than that of group B (P<0.05). The VAS scores of both groups decreased to the preoperative level at 3 months after operation, and there was no significant difference between the two groups (P>0.05). At 3 months after operation and at last follow-up, the MEPS scores of both groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between the two groups (P>0.05). At last follow-up, the postoperative elbow flexion and extension activity of the two groups significantly increased when compared with that before operation (P<0.05); there was no significant difference in change of elbow flexion and extension activity between the two groups (P>0.05). ConclusionIntravenous tranexamic acid for 3 consecutive days after release of traumatic elbow stiffness can significantly reduce postoperative drainage volume, shorten drainage tube indwelling time and hospital stay, and relieve early postoperative pain, but it has no effect on the risk of thrombotic and embolic events and postoperative elbow function.
ObjectiveTo evaluate the effectiveness and safety of tranexamic acid (TXA) combined with intraoperative controlled hypotension (ICH) for reducing perioperative blood loss in primary total hip arthroplasty (THA).MethodsThe clinical data of 832 patients with initial THA due to osteonecrosis of femoral head between January 2017 and July 2020 were retrospectively analyzed. All patients received TXA treatment, and 439 patients (hypotension group) received ICH treatment with an intraoperative mean arterial pressure (MAP) below 80 mm Hg (1 mm Hg=0.133 kPa) while 393 patients (normotension group) received standard general anesthesia with no special invention on blood pressure. There was no significant difference in age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, basic arterial pressure, hip range of motion, internal diseases, preoperative hemoglobin (HB) and hematocrit (HCT), coagulation function, surgical approach, and TXA dosage between the two groups (P>0.05). The perioperative blood loss and blood transfusion, anesthesia and operation time, hospitalization stay, postoperative range of motion, and complications were recorded and compared between the two groups. The patients were further divided into MAP<70 mm Hg group (group A), MAP 70-80 mm Hg group (group B), and normotension group (group C). The perioperative blood loss and postoperative complications were further analyzed to screen the best range of blood pressure.ResultsThe intraoperative MAP, total blood loss, dominant blood loss, recessive blood loss, blood transfusion rate and blood transfusion volume, anesthesia time, operation time, and hospitalizarion stay in the hypotension group were significantly lower than those in the normotension group (P<0.05). The postoperative hip flexion range of motion in the hypotension group was significantly better than that of the normotension group (Z=2.743, P=0.006), but there was no significant difference in the abduction range of motion between the two groups (Z=0.338, P=0.735). In terms of postoperative complications, the incidence of postoperative hypotension in the hypotension group was significantly higher than that in the normotension group (χ2=6.096, P=0.014), and there was no significant difference in the incidence of other complications (P>0.05). There was no stroke, pulmonary embolism, or deep vein thrombosis in the two groups, and no patients died during hospitalization. Subgroup analysis showed that there was no significant difference in total blood loss, dominant blood loss, and recessive blood loss in groups A and B during the perioperative period (P>0.05), which were significantly lower than those in group C (P<0.05). There was no significant difference in blood transfusion rate, blood transfusion volume, and incidence of acute myocardial injury between 3 groups (P>0.05); the incidence of acute kidney injury in group A was significantly higher than that in group B, and the incidence of postoperative hypotension in group A was significantly higher than that in groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05).ConclusionThe combination of TXA and ICH has a synergistic effect. Controlling the intraoperative MAP at 70-80 mm Hg can effectively reduce the perioperative blood loss during the initial THA, and it is not accompanied by postoperative complications.
ObjectiveTo review the advances in the application of tranexamic acid (TXA) in adolescent spinal corrective surgery.MethodsThe mechanism of action and pharmacokinetic, effectiveness, dosage, safety as well as methods of administration were comprehensively summarized by consulting domestic and overseas related literature about the application of TXA in adolescent spinal corrective surgery in recent years.ResultsTXA efficaciously reduce intraoperative blood loss, transfusion rate and volume, postoperative drainage volume in adolescent spinal corrective surgery. At present, the most common method of administration in adolescent spinal corrective surgery is that a loading dose is given intravenously before skin incision or induction of anesthesia, followed by a maintenance dose until the end of the surgery. The range of loading dose and maintenance dose is 10-100 mg/kg and 1-10 mg/(kg·h), respectively. No drug related adverse event has been reported in this range.ConclusionThe effectiveness and safety of TXA in adolescent spinal surgery have been basically confirmed. However, further studies are needed to determine the optimal dosage, method of administration as well as whether it could reduce blood loss after surgery.
ObjectiveTo investigate the effect and safety of tranexamic acid sequential rivaroxaban on perioperative blood loss and preventing thrombosis for elderly patients during lumbar interbody fusion (LIF) with a prospective randomized controlled study.MethodsBetween April and October 2019, the elderly patients with lumbar degenerative diseases requiring LIF were included in the study, among which were 80 patients met the selection criteria. According to the antifibrinolysis and anticoagulation protocols, they were randomly divided into a tranexamic acid sequential rivaroxaban group (trial group) and a simple rivaroxaban group (control group) on average. Finally, 69 patients (35 in the trial group and 34 in the control group) were included for comparison. There was no significant difference in general data (P>0.05) such as gender, age, body mass index, disease duration, diseased segment, type of disease, and preoperative hemoglobin between the two groups. The operation time, intraoperative blood loss, drainage within 3 days after operation, perioperative total blood loss, and proportion of blood transfusion patients were compared between the two groups, as well as postoperative venous thrombosis of lower extremities, pulmonary embolism, and bleeding-related complications.ResultsThe operations of the two groups completed successfully, and there was no significant difference in the operation time (P>0.05); the intraoperative blood loss, drainage within 3 days after operation, and perioperative total blood loss in the trial group were significantly lower than those in the control group (P<0.05). The proportion of blood transfusion patients in the trial group was 25.71% (9/35), which was significantly lower than that in the control group [52.94% (18/34)] (χ2=5.368, P=0.021). Postoperative incision bleeding occurred in 4 cases of the trial group and 3 cases of the control group, and there was no significant difference in bleeding-related complications between the two groups (P=1.000). There was 1 case of venous thrombosis of the lower extremities in each group after operation, and there was no significant difference in the incidence between the two groups (P=1.000). Besides, no pulmonary embolism occurred in the two groups.ConclusionPerioperative use of tranexamic acid sequential rivaroxaban in elderly LIF patients can effectively reduce the amount of blood loss and the proportion of blood transfusion patients without increasing the risk of postoperative thrombosis.
Objective To evaluate the effectiveness and safety of intraoperative tranexamic acid use in total shoulder arthroplasty. Methods By searching Cochrane Library, PubMed, Embase, Chongqing VIP, Chinese National Knowledge Infrastructure, Wanfang Database from the establishment of the database to September 2021, randomized controlled trials of intraoperative tranexamic acid use in total shoulder arthroplasty were collected. Outcome indicators were total blood loss, postoperative drainage, hemoglobin reduction, length of operation, length of hospital stay, and formation of hematoma. RevMan 5.3 software was used for meta-analysis. Results Meta analysis results showed that the use of tranexamic acid can reduce total blood loss [weighted mean difference = −246.55 mL, 95% confidence interval (−335.36, −157.75) mL, P<0.000 01], reduce postoperative drainage [weighted mean difference = −134.05 mL, 95% confidence interval (−161.72, −106.38) mL, P<0.000 01], reduce hemoglobin reduction [weighted mean difference = −0.64 g/dL, 95% confidence interval (−0.91, −0.36) g/dL, P< 0.000 01], reduce hematoma formation [risk ratio=0.41, 95% confidence interval (0.22, 0.77), P=0.005]. There was no statistically significant difference in the length of operation and length of hospitalization between patients who used tranexamic acid and those who did not use tranexamic acid (P>0.05). Conclusions Tranexamic acid is effective and safe for patients undergoing total shoulder arthroplasty. It can reduce perioperative bleeding and hematoma formation without increasing the length of surgery and hospitalization.
ObjectiveTo explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA).MethodsPatients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups (n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups (P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups.ResultsThe total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A (P<0.05), and the total blood loss and hidden blood loss were significantly lower in group C than those in group B (P<0.05). There was no significant difference in the blood transfusion rate, preoperative VAS scores and the levels of PGE2 and BK between groups (P>0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B (P<0.05). There was no significant difference in pre- and post-operative MA of thromboelastogram between groups (P>0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups (χ2=1.721, P=0.550).ConclusionFor intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.