Comparison between intravenous and periarticular administration of tranexamic acid in total knee replacement surgery: a study of two consecutive cohorts
DOI:
https://doi.org/10.58814/01208845.26Keywords:
Tranexamic Acid, Orthopedics, Arthroplasty, Replacement, Knee, BleedingAbstract
Introduction: Tranexamic acid (TA) has been reported as useful in the management of postoperative bleeding in patients undergoing total knee arthroplasty (TKA), but there is no consensus on its dosage and route of administration.
Objective: To evaluate and compare the efficacy of intravenous and periarticular administration of TA in patients undergoing TKA to reduce postoperative bleeding.
Methodology: Observational study conducted with 72 patients operated on between 2021 and 2022 in a secondary care center in Barcelona (Spain). Patients were divided into 2 groups depending on the route of TA administration (group 1: intravenous administration of two doses, an intraoperative dose of 15mg/kg and a postoperative dose of 10mg/kg; group 2: periarticular infiltration of 2g). A bivariate analysis was performed using Student's t-test to evaluate the differences between groups.
Results: The mean age of the patients was 73.72 years in group 1 and 72.96 years in group 2. A decrease in preoperative and 24-hour hemoglobin levels was observed in both groups (group 1: 2.1 mg/dL; group 2: 2.14 mg/dL). One patient in group 2 presented pulmonary embolism and another required red blood cell transfusion.
Conclusions: The use of TA, both intravenous and locally administered, reduces postoperative bleeding in patients undergoing TKA. There were no statistically significant differences in the decrease of postoperative hemoglobin levels between groups.
Downloads
References
Levine BR, Springer BD, Golladay GJ. Highlights of the 2019 American Joint Replacement Registry Annual Report. Arthroplast Today. 2020;6(4):998-1000. https://doi.org/gndqkj.
Rasouli MR, Maltenfort MG, Erkocak OF, Austin MS, Waters JH, Parvizi J. Blood management after total joint arthroplasty in the United States: 19-year trend analysis. Transfusion. 2016;56(5):1112-20. https://doi.org/f8s8nn.
Zaidi R, Cro S, Gurusamy K, Siva N, Macgregor A, Henricson A, et al. The outcome of total ankle replacement: a systematic review and meta-analysis. Bone Joint J. 2013;95(11):133-137. https://doi.org/k6q8.
Aguilera-Roig X, Jordán-Sales M, Natera-Cisneros L, Monllau-García JC, Martínez-Zapata MJ. Ácido tranexámico en cirugía ortopédica. Rev Esp Cir Ortop Traumatol. 2014;58(1):52-56. https://doi.org/f2nbfm.
Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Bini SA, Clarke HD, et al. Tranexamic Acid Use in Total Joint Arthroplasty: The Clinical Practice Guidelines Endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty. 2018;33(10):3065-69. https://doi.org/k6q9.
Pitta M, Zawadsky M, Verstraete R, Rubinstein A. Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610-patient consecutive case series. ransfusion. 2016;56(2):466-71. https://doi.org/k6rb.
Peng HM, Wang W, Lin J, Weng XS, Qian WW, Wang WD. Multimodal Peri-articular Injection with Tranexamic Acid can reduce postoperative blood loss versus Intravenous Tranexamic Acid in Total Knee Arthroplasty: A Randomized Controlled Trial. J Orthop Surg Res. 2021;16(1):546. https://doi.org/k6rc.
Lin ZX, Woolf SK. Safety, efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery. Orthopedics. 2016;39(2):119-30. https://doi.org/f8rdw4.
Shemshaki H, Nourian SMA, Nourian N, Dehghani M, Mokhtari M, Mazoochian F. One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Arch Orthop Trauma Surg. 2015;135(4):573-88. https://doi.org/f65s3f.
Xiong H, Liu Y, Zeng Y, Wu Y, Shen B. The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: A meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2018;19(1):321. https://doi.org/k6rd.
World Medical Association (WMA). WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013.
Poeran J, Rasul R, Suzuki S, Danninger T, Mazumdar M, Opperer M, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: Retrospective analysis of effectiveness and safety. BMJ. 2014;349:g4829. https://doi.org/gb3snj.
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(13):1153-59. https://doi.org/gf2vgj.
Canillas F, Gómez-Ramírez S, García-Erce JA, Pavía-Molina J, Gómez-Luque A, Muñoz M. “Patient blood management” in orthopaedic surgery. Rev Esp Cir Ortop Traumatol. 2015;59(3):137-49. https://doi.org/f2zgfn.
Agencia Española del Medicamento y Productos Sanitarios. Ficha técnica de ácido tranexámico (Amchafibrin 500mg Solución inyectable) [Revised 2021 Jun. Cited 2022 Sep 12]. Available at: https://bit.ly/4a6TnV2.
Castro-Menéndez M, Pena-Paz S, Rocha-García F, Rodríguez-Casas N, Huici-Izco R, Montero-Viéites A. Eficacia de 2 gramos intravenosos de ácido tranexámico en la reducción del sangrado postoperatorio de la artroplastia total de cadera y rodilla. Rev Esp Cir Ortop Traumatol. 2016;60(5):315-24. https://doi.org/k6rf.
Lee SY, Chong S, Balasubramanian D, Na YG, Kim TK. What is the Ideal Route of Administration of Tranexamic Acid in TKA? A Randomized Controlled Trial. Clin Orthop Relat Res. 2017;475(8):1987-96. https://doi.org/k6rh.
Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Pérez-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(23):1937-44. https://doi.org/k6rj.
Chen JY, Chin PL, Moo IH, Pang HN, Tay DK, Chia SL, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial. The Knee. 2016;23(1):152-56. https://doi.org/k6rm.
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 knee. Clin Orthop Relat Res. 2012;470(9):2605-12. https://doi.org/f38vq5.
Pinsornsak P, Phunphakchit J, Boontanapibul K. Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Arthroplast Today. 2021;11:1-5. https://doi.org/k6rq.
Pinsornsak P, Rojanavijitkul S, Chumchuen S. Peri-articular tranexamic acid injection in total knee arthroplasty: A randomized controlled trial. BMC Musculoskelet Disord. 2016;17(1):313. https://doi.org/f9xd4w.
Sarzaeem MM, Razi M, Kazemian G, Moghaddam ME, Rasi AM, Karimi M. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty. J Arthroplasty. 2014;29(8):1521-24. https://doi.org/f6gg8p.
Zhang S, Wang C, Shi L, Xue Q. Multi-route applications of tranexamic acid to reduce blood loss after total knee arthroplasty: A randomized controlled trial. Medicine (Baltimore). 2019;98(30):1-8.https://doi.org/k6rr.
Aguado-Maestro I, Cebrián-Rodríguez E, Fraile-Castelao O, Rodríguez-López RJ, de Blas-Sanz I, Rizzo-Raza S, et al. Implementation of a rapid recovery protocol in total knee arthroplasty. A randomized controlled trial. Rev Esp Cir Ortop Traumatol. 2022;66(5):380-88. https://doi.org/k6rg.
Alshryda S, Mason J, Vaghela M, Sarda P, Nargol A, Maheswaran S, 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):1961-68. https://doi.org/k6rp.
Chen JY, Chia SL, Lo NN, Yeo SJ. Intra-articular versus intravenous tranexamic acid in primary total knee replacement. Ann Transl Med. 2015;3(3):33. https://doi.org/k6rn.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Revista Colombiana de ortopedia y traumatología
This work is licensed under a Creative Commons Attribution 3.0 Unported License.
Derechos de autor
Los autores aceptar transferir a la Revista Colombiana de Ortopedia y Traumatología los derechos edición, publicación y reproducción de los artículos publicados. La editorial tiene el derecho del uso, reproducción, transmisión, distribución y publicación en cualquier forma o medio. Los autores no podrán permitir o autorizar el uso de la contribución sin el consentimiento escrito de la revista. Una vez firmada por todos los autores, la carta de Cesión de derechos debe ser cargada en el paso dos del envío.
Aquellos autores que tengan publicaciones en esta revista aceptan los siguientes términos:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web), lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
