What is the Ideal Route of Administration of Tranexamic Acid in TKA? A Randomized Controlled Trial

Clinical Orthopaedics and Related Research

Volumn 475, Issue 8, 2017, Pages 1987-1996

  Lee, Sung Yup ^a   Chong, Suri ^a   Balasubramanian, Dhanasekaraprabu ^a   Na, Young Gon ^b   Kim, Tae Kyun ^a  

^a Seoul National University Bundang Hospital   (South Korea)

^b Gachon University   (South Korea)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ERYTHROPOIETIN; HEMOGLOBIN; IRON; LOW MOLECULAR WEIGHT HEPARIN; RIVAROXABAN; TRANEXAMIC ACID; WARFARIN; ANTIFIBRINOLYTIC AGENT;

AGED; ALLOGENEIC BLOOD TRANSFUSION; ANTICOAGULANT THERAPY; ARTICLE; BLOOD TRANSFUSION; BLOOD VOLUME; CLINICAL DECISION MAKING; COMPARATIVE EFFECTIVENESS; CONTROLLED STUDY; DEEP VEIN THROMBOSIS; DRUG DOSE COMPARISON; DRUG EFFICACY; DRUG MEGADOSE; ERYTHROCYTE TRANSFUSION; FEMALE; HEMOGLOBIN BLOOD LEVEL; HUMAN; INTERMITTENT PNEUMATIC COMPRESSION DEVICE; IRON THERAPY; LOW DRUG DOSE; LUNG EMBOLISM; MAJOR CLINICAL STUDY; MALE; NECROSIS; OUTCOME ASSESSMENT; PERIPROSTHETIC JOINT INFECTION; POSTOPERATIVE HEMORRHAGE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; SURGICAL PATIENT; THROMBOSIS PREVENTION; TOTAL KNEE ARTHROPLASTY; VENOUS THROMBOEMBOLISM; WOUND; WOUND COMPLICATION; WOUND NECROSIS; ADVERSE EFFECTS; DRUG ADMINISTRATION ROUTE; INTRAARTICULAR DRUG ADMINISTRATION; INTRAVENOUS DRUG ADMINISTRATION; KNEE REPLACEMENT; PROCEDURES; STATISTICS AND NUMERICAL DATA; TREATMENT OUTCOME;

ADMINISTRATION, INTRAVENOUS; AGED; ANTIFIBRINOLYTIC AGENTS; ARTHROPLASTY, REPLACEMENT, KNEE; BLOOD TRANSFUSION; DRUG ADMINISTRATION ROUTES; FEMALE; HEMOGLOBINS; HUMANS; INJECTIONS, INTRA-ARTICULAR; MALE; POSTOPERATIVE HEMORRHAGE; TRANEXAMIC ACID; TREATMENT OUTCOME; VENOUS THROMBOEMBOLISM;

EID: 85014736375     PISSN: 0009921X     EISSN: 15281132     Source Type: Journal    
DOI: 10.1007/s11999-017-5311-z     Document Type: Article

References (55)

1. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM. Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br. 2011;93:1577–1585.
2. Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J. 2014;96:1005–1015.
3. Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion. 2008;48:519–525.
4. Astedt B, Liedholm P, Wingerup L. The effect of tranexamic acid on the fibrinolytic activity of vein walls. Ann Chir Gynaecol. 1978;67:203–205.
5. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br. 1996;78:434–440.
6. Camarasa Godoy MA, Serra-Prat M, Palomera Fanegas E. Effectiveness of tranexamic acid in routine performance of total knee replacement surgery. Rev Esp Anestesiol Reanim. 2008;55:75–80.
7. Charoencholvanich K, Siriwattanasakul P. Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res. 2011;469:2874–2880.
8. Chen JY, Chin PL, Moo IH, Pang HN, Tay DK, Chia SL, Lo NN, Yeo SJ. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: a double-blinded randomised controlled noninferiority trial. Knee. 2016;23:152–156.
9. Chen Y, Chen Z, Cui S, Li Z, Yuan Z. Topical versus systemic tranexamic acid after total knee and hip arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016;95:e4656.
10. Cho HJ, Chang CB, Kim KW, Park JH, Yoo JH, Koh IJ, Kim TK. Gender and prevalence of knee osteoarthritis types in elderly Koreans. J Arthroplasty. 2011;26:994–999.
11. Cushner FD, Friedman RJ. Blood loss in total knee arthroplasty. Clin Orthop Relat Res. 1991;269:98–101.
12. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999;57:1005–1032.
13. Engel JM, Hohaus T, Ruwoldt R, Menges T, Jurgensen I, Hempelmann G. Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or aprotinin. Anesth Analg. 2001;92:775–780.
14. Fakhry SM, Fata P. How low is too low? Cardiac risks with anemia. Crit Care. 2004;8(suppl 2):S11–14.
15. Fiebig E. Safety of the blood supply. Clin Orthop Relat Res. 1998;357:6–18.
16. Fu Y, Shi Z, Han B, Ye Y, You T, Jing J, Li J. Comparing efficacy and safety of 2 methods of tranexamic acid administration in reducing blood loss following total knee arthroplasty: a meta-analysis. Medicine (Baltimore). 2016;95:e5583.
17. Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Perez-Chrzanowska H, Figueredo-Zalve R. 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. 2014;96:1937–1944.
18. 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;90:596–599.
19. Hamlin BR, DiGioia AM, Plakseychuk AY, Levison TJ. Topical versus intravenous tranexamic acid in total knee arthroplasty. J Arthroplasty. 2015;30:384–386.
20. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409–417.
21. Hiippala S, Strid L, Wennerstrand M, Arvela V, Mantyla S, Ylinen J, Niemela H. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth. 1995;74:534–537.
22. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemela HM, Mantyla SK, Kuisma RP, Ylinen JE. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg. 1997;84:839–844.
23. Ho KM, Ismail H. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care. 2003;31:529–537.
24. Huang Z, Ma J, Shen B, Pei F. Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2014;29:2342–2346.
25. 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. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011;35:1639–1645.
26. Jain NP, Nisthane PP, Shah NA. 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. J Arthroplasty. 2016;31:542–547.
27. Jansen AJ, Andreica S, Claeys M, D’Haese J, Camu F, Jochmans K. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth. 1999;83:596–601.
28. Kim HA, Kim S, Seo YI, Choi HJ, Seong SC, Song YW, Hunter D, Zhang Y. The epidemiology of total knee replacement in South Korea: national registry data. Rheumatology (Oxford). 2008;47:88–91.
29. Kim TK, Chang CB, Kang YG, Seo ES, Lee JH, Yun JH, Lee SH. Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2014;22:1870–1878.
30. Kim TK, Chang CB, Koh IJ. Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22:1849–1858.
31. Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty. 2013;28:1473–1476.
32. Levine BR, Haughom B, Strong B, Hellman M, Frank RM. Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg. 2014;22:361–371.
33. Lin SY, Chen CH, Fu YC, Huang PJ, Chang JK, Huang HT. 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;30:776–780.
34. Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012;470:2605–2612.
35. May JH, Rieser GR, Williams CG, Markert RJ, Bauman RD, Lawless MW. The assessment of blood loss during total knee arthroplasty when comparing intravenous vs intracapsular administration of tranexamic acid. J Arthroplasty. 2016;31:2452–2457.
36. Melvin JS, Stryker LS, Sierra RJ. Tranexamic acid in hip and knee arthroplasty. J Am Acad Orthop Surg. 2015;23:732–740.
37. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224–232.
38. Nielsen CS, Jans O, Orsnes T, Foss NB, Troelsen A, Husted H. Combined intra-articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2016;98:835–841.
39. Pierson JL, Hannon TJ, Earles DR. A blood-conservation algorithm to reduce blood transfusions after total hip and knee arthroplasty. J Bone Joint Surg Am. 2004;86:1512–1518.
40. 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;18:65–66.
41. Roy SP, Tanki UF, Dutta A, Jain SK, Nagi ON. Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20:2494–2501.
42. Royston D. Blood-sparing drugs: aprotinin, tranexamic acid, and epsilon-aminocaproic acid. Int Anesthesiol Clin. 1995;33:155–179.
43. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee. 2000;7:151–155.
44. Seo ES, Yoon SW, Koh IJ, Chang CB, Kim TK. Subcutaneous versus intraarticular indwelling closed suction drainage after TKA: a randomized controlled trial. Clin Orthop Relat Res. 2010;468:2168–2176.
45. Seo JG, Moon YW, Park SH, Kim SM, Ko KR. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21:1869–1874.
46. Serrano Mateo L, Goudarz Mehdikhani K, Cáceres L, Lee YY, Gonzalez Della Valle A. Topical tranexamic acid may improve early functional outcomes of primary total knee arthroplasty. J Arthroplasty.2016;31:1449–1452.
47. Shin YS, Yoon JR, Lee HN, Park SH, Lee DH. Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016 July 14. [Epub ahead of print].
48. Song EK, Seon JK, Prakash J, Seol YJ, Park YJ, Jin C. Combined administration of IV and topical tranexamic acid is not superior to either individually in primary navigated TKA. J Arthroplasty. 2017;32:37–42.
49. Veien M, Sorensen JV, Madsen F, Juelsgaard P. Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study. Acta Anaesthesiol Scand. 2002;46:1206–1211.
50. Wang H, Shen B, Zeng Y. Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. Knee. 2014;21:987–993.
51. 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. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am. 2010;92:2503–2513.
52. Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2012;94:1153–1159.
53. Yuan ZF, Yin H, Ma WP, Xing DL. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: combined tranexamic acid for TKA. Bone Joint Res. 2016;5:353–361.
54. Zhang H, Chen J, Chen F, Que W. 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;20:1742–1752.
55. Zohar E, Fredman B, Ellis M, Luban I, Stern A, Jedeikin R. A comparative study of the postoperative allogeneic blood-sparing effect of tranexamic acid versus acute normovolemic hemodilution after total knee replacement. Anesth Analg. 1999;89:1382–1387.