Primary ArthroplastyCombined Administration of IV and Topical Tranexamic Acid is Not Superior to Either Individually in Primary Navigated TKA
Section snippets
Patient's Selection
The study was approved by institutional review board and was conducted under the ethical norms laid down by Declaration of Helsinki, 1964. Informed consent was sought from all participating patients.
A single-institution 2 hospital based, double blinded, prospective randomized control trial was conducted. All patients with diagnosis of primary osteoarthritis of knee awaiting navigation-assisted surgery from January 2015 to December 2015 were eligible for the trial. Exclusion criterion included
Results
The consort flow diagram presented outlined the study (Fig. 1). A total of 200 patients with 50 patients in each group participated in the trial. All patients were Korean in origin and did not differ significantly in basic demographic details and preoperative variables. The patients receiving chemical prophylaxis for DVT were statistically similar in distribution in all 4 groups (P = .61) (Table 1).
Results of primary output variables are detailed in Table 2. All 3 TXA groups were better than
Discussion
The main findings of the study are that TXA is useful in patients undergoing navigation-assisted total knee arthroplasty. However, contrary to reports on conventional arthroplasty, combine group has no added advantage over other methods of drug administration for blood loss, postoperative swelling, or transfusion rates in patients undergoing navigation total knee arthroplasty 11, 12. We believe that additional amount of TXA administered in combined regimen may not be clinically useful and
Conclusion
Combined group has no added advantage over other methods of drug administration for blood loss, postoperative swelling, or transfusion rates in patients undergoing navigation total knee arthroplasty. We believe that additional amount of TXA administered in combined regimen may not be clinically useful and should therefore be avoided. Further TXA group did not have any advantage in terms of functional recovery over control group.
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Is There a Synergistic Effect of Topical Plus Intravenous Tranexamic Acid Versus Intravenous Administration Alone on Blood Loss and Transfusions in Primary Total Hip and Knee Arthroplasties?
2021, Arthroplasty TodayCitation Excerpt :Furthermore, multivariate analysis revealed that lower preoperative Hgb and higher ASA classes were independent risk factors for a postoperative blood transfusion rather than TXA dosing regimen, risk factors well outlined in the literature [27,28]. The studies that show a positive synergistic effect of combined IV and topical TXA compare only a single dose of either IV or topical TXA to the combined dosing regimen [20-23]. A prospective study of patients undergoing primary TKA with either topical or IV TXA administration showed no significant difference of systemic or wound TXA levels, suggesting that both routes are systemically effective [5].
Administration of Tranexamic Acid Improves Long-Term Outcomes in Total Knee Arthroplasty
2020, Journal of ArthroplastyCitation Excerpt :In this cohort, 4423 patients were administered TXA during the TKA procedure and 18,998 patients were not administered TXA. As multiple studies have demonstrated no difference in transfusion rates between topical, intravenous, and oral administration of TXA, these were pooled into one group [21–26]. Of those undergoing TKA who were administered TXA, 61% were intravenous, 23% were oral, and 16% were topical.
The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis
2018, Journal of ArthroplastyThe Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Meta-Analysis
2018, Journal of ArthroplastyCitation Excerpt :After completion of the quality assessment, only randomized clinical trials representing the highest quality of evidence remained, leaving 79 publications with 7164 patients to be included for our meta-analysis of VTE or ATE. After the quality assessment, 78 randomized clinical trials were available for the meta-analysis of VTE encompassing 7044 patients (Table 1) [15–92]. Published randomized clinical trials included comparisons between placebo and IV, topical, oral, combined IV/topical, or combined IV/oral TXA.
Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis
2024, Cochrane Database of Systematic Reviews
Authors declare that no funding was received.
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.06.052.