Combined Administration of Systemic and Topical Tranexamic Acid for Total Knee Arthroplasty: Can It Be a Better Regimen and Yet Safe? A Randomized Controlled Trial

Journal of Arthroplasty

Volumn 31, Issue 2, 2016, Pages 542-547

  Jain, Nimesh P ^a   Nisthane, Prithviraj P ^a   Shah, Nilen A ^a  

^a BOMBAY HOSPITAL   (India)

Author keywords

Allogeneic blood transfusion; Blood loss; Intraarticular; Intravenous; Total knee arthroplasty

Indexed keywords

HEMOGLOBIN; TRANEXAMIC ACID; ANTIFIBRINOLYTIC AGENT;

AGED; ARTHROTOMY; ARTICLE; BLOOD TRANSFUSION; COMPARATIVE EFFECTIVENESS; CONTROLLED STUDY; DEEP VEIN THROMBOSIS; DRUG DOSE REGIMEN; DRUG SAFETY; FEMALE; FIBRINOLYSIS; HEMOGLOBIN BLOOD LEVEL; HUMAN; INCIDENCE; MAJOR CLINICAL STUDY; MALE; OPERATIVE BLOOD LOSS; OSTEOARTHRITIS; POSTOPERATIVE PERIOD; PREOPERATIVE PERIOD; RANDOMIZED CONTROLLED TRIAL; THROMBOEMBOLISM; TOTAL KNEE REPLACEMENT; UNILATERAL TOTAL KNEE ARTHROPLASTY; CHEMICALLY INDUCED; CLINICAL PROTOCOL; INTRAVENOUS DRUG ADMINISTRATION; KNEE REPLACEMENT; MIDDLE AGED; MULTIMODALITY CANCER THERAPY; POSTOPERATIVE HEMORRHAGE; STATISTICS AND NUMERICAL DATA; TOPICAL DRUG ADMINISTRATION; VEIN THROMBOSIS;

ADMINISTRATION, INTRAVENOUS; ADMINISTRATION, TOPICAL; AGED; ANTIFIBRINOLYTIC AGENTS; ARTHROPLASTY, REPLACEMENT, KNEE; BLOOD TRANSFUSION; CLINICAL PROTOCOLS; COMBINED MODALITY THERAPY; FEMALE; HUMANS; INFUSIONS, INTRAVENOUS; MALE; MIDDLE AGED; POSTOPERATIVE HEMORRHAGE; POSTOPERATIVE PERIOD; THROMBOEMBOLISM; TRANEXAMIC ACID; VENOUS THROMBOSIS;

EID: 84957838500     PISSN: 08835403     EISSN: 15328406     Source Type: Journal    
DOI: 10.1016/j.arth.2015.09.029     Document Type: Article

References (50)

1. Callaghan J.J., O'Rourke M.R., Liu S.S. Blood management: issues and options. J Arthroplasty 2005, 20(Suppl. 2):51.
2. Wong J., Abrishami A., El Beheiry H., et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 2010, 92(15):2503.
3. Hiippala S.T., Strid L.J., Wennerstrand M.I., et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 1997, 84(4):839.
4. Charoencholvanich K., Siriwattanasakul P. Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res 2011, 469(10):2874.
5. Risberg B. The response of the fibrinolytic system in trauma. Acta Chir Scand Suppl 1985, 522:245.
6. Fahmy N.R., Patel D.G. Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet. J Bone Joint Surg Am 1981, 63(3):461.
7. Juelsgaard P., Larsen U.T., Sorenson J.V., et al. Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Reg Anesth Pain Med 2001, 26(2):105.
8. Raut V.V., Stone M.H., Wroblewski B.M. Reduction of postoperative blood loss after press-fit condylar knee arthroplasty with use of a femoral intramedullary plug. J Bone Joint Surg Am 1993, 75(9):1356.
9. Raleigh E., Hing C.B., Hanusiewicz A.S., et al. Drain clamping in knee arthroplasty, a randomized controlled trial. ANZ J Surg 2007, 77(5):333.
10. Dalen T., Brostrom L.A., Engstrom K.G. Autotransfusion after total knee arthroplasty. Effects on blood cells, plasma chemistry, and whole blood rheology. J Arthroplasty 1997, 12(5):517.
11. Dunn C.J., Goa K.L. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999, 57(6):1005.
12. Astedt B. Clinical pharmacology of tranexamic acid. Scand J Gastroenterol Suppl 1987, 137:22.
13. Ker K., Edwards P., Perel P., et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012, 344:e3054.
14. Benoni G., Carlsson A., Petersson C., et al. Does tranexamic acid reduce blood loss in knee arthroplasty?. Am J Knee Surg 1995, 8(3):88.
15. Camarasa Godoy M.A., Serra-Prat M., Palomera Fanegas E. Effectiveness of tranexamic acid in routine performance of total knee replacement surgery. Rev Esp Anestesiol Reanim 2008, 55(2):75.
16. Good L., Peterson E., Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 2003, 90(5):596.
17. Jansen A.J., Andreica S., Claeys M., et al. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth 1999, 83(4):596.
18. Alshryda S., Sarda P., Sukiek M., et al. Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg (Br) 2011, 93(12):1577.
19. Yang Z.G., Chen W.P., Wu L.D. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 2012, 94(13):1153.
20. Zhang H., Chen J., Chen F., et al. 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 2012, 20(9):1742.
21. Pfizer Product information. Cyklokapron (tranexamic acid) 2011.
22. Astedt B., Liedholm P., Wingerup L. The effect of tranexamic acid on the fibrinolytic activity of vein walls. Ann Chir Gynaecol 1978, 67(6):203.
23. Eubanks J.D. Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg 2010, 18(3):132.
24. Hynes M., Calder P., Scott G. The use of tranexamic acid to reduce blood loss during total knee arthroplasty. Knee 2003, 10(4):375.
25. Horrow J.C., Van Riper D.F., Strong M.D., et al. The dose-response relationship of tranexamic acid. Anesthesiology 1995, 82(2):383.
26. Ngaage D.L., Bland J.M. Lessons from aprotinin: is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies. Eur J Cardiothorac Surg 2010, 37(6):1375.
27. Raveendran R., Wong J. Tranexamic acid reduces blood transfusion in surgical patients while its effects on thromboembolic events and mortality are uncertain. Evid Based Med 2013, 18(2):65.
28. Alshryda S., Mason J., Vaghela M., et al. 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 2013, 95(21):1961.
29. Maniar R.N., Kumar G., Singhi T., et al. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 2012, 470(9):2605.
30. Seo J.G., Moon Y.W., Park S.H., et al. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013, 21(8):1869.
31. Panteli M., Papakostidis C., Dahabreh Z., et al. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 2013, 20(5):300.
32. Lin S.Y., Chen C.H., Fu Y.C., et al. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty. J Arthroplasty 2015, 30(5):776.
33. Pierson J.L., Hannon T.J., Earles D.R. A blood-conservation algorithm to reduce blood transfusions after total hip and knee arthroplasty. J Bone Joint Surg Am 2004, 86-a(7):1512.
34. Bozic K.J., Vail T.P., Pekow P.S., et al. Does aspirin have a role in venous thromboembolism prophylaxis in total knee arthroplasty patients?. J Arthroplasty 2010, 25(7):1053.
35. Lotke P.A., Lonner J.H. The benefit of aspirin chemoprophylaxis for thromboembolism after total knee arthroplasty. Clin Orthop Relat Res 2006, 452:175.
36. Nadler S.B., Hidalgo J.H., Bloch T. Prediction of blood volume in normal human adults. Surgery 1962, 51(2):224.
37. Benoni G., Bjorkman S., Fredin H. Application of pharmacokinetics data from healthy volunteers for the prediction of plasma concentrations of tranexamic acid in surgical patients. Clin Drug Investig 1995, 10:280.
38. Sano M., Hakusui H., Kojima C., et al. Absorption and excretion of tranexamic acid following intravenous, intramuscular and oral administrations in healthy volunteers. Jpn J Clin Pharmacol Ther 1976, 7:375.
39. Royston D. Blood-sparing drugs: aprotinin, tranexamic acid, and epsilon-aminocaproic acid. Int Anesthesiol Clin 1995, 33(1):155.
40. Mannucci P.M. Hemostatic drugs. N Engl J Med 1998, 339(4):245.
41. Eriksson O., Kjellman H., Pilbrant A., et al. Pharmacokinetics of tranexamic acid after intravenous administration to normal volunteers. Eur J Clin Pharmacol 1974, 7(5):375.
42. Tanaka N., Sakahashi H., Sato E., et al. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg (Br) 2001, 83(5):702.
43. Reikeras O., Clementsen T. Time course of thrombosis and fibrinolysis in total knee arthroplasty with tourniquet application. Local versus systemic activations. J Thromb Thrombolysis 2009, 28(4):425.
44. Sperzel M., Huetter J. Evaluation of aprotinin and tranexamic acid in different in vitro and in vivo models of fibrinolysis, coagulation and thrombus formation. J Thromb Haemost 2007, 5(10):2113.
45. Damji K.F., Noel L.P., Peterson R.G., et al. Topical versus intravenous administration of tranexamic acid: a comparison of intraocular and serum concentrations in the rabbit. Can J Ophthalmol 1998, 33(6):308.
46. Lee W.S., Kim K.I., Lee H.J., et al. The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: a meta-analysis. Clin Orthop Relat Res 2013, 471(5):1523.
47. Zhang W., Li N., Chen S., et al. The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res 2014, 9(1):13.
48. Kim T.K., Chang C.B., Koh I.J. Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014, 22(8):1849.
49. Karski J.M., Dowd N.P., Joiner R., et al. The effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32 degrees C). J Cardiothorac Vasc Anesth 1998, 12(6):642.
50. Murkin J.M., Falter F., Granton J., et al. High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg 2010, 110(2):350.