The Efficacy of Intravenous Versus Topical Use of Tranexamic Acid in Reducing Blood Loss after Primary Total Knee Arthroplasty: A Randomized Clinical Trial | ||
| The Archives of Bone and Joint Surgery | ||
| دوره 8، شماره 3، مرداد 2020، صفحه 363-367 اصل مقاله (383.35 K) | ||
| نوع مقاله: RESEARCH PAPER | ||
| شناسه دیجیتال (DOI): 10.22038/abjs.2020.40528.2099 | ||
| نویسندگان | ||
| Ali Torkaman1؛ Amir Rostami2؛ Mohammad Reza Sarshar3؛ Hamidreza Yazdi* 2؛ Hossein Akbari Aghdam* 4؛ Paniz Motaghi5 | ||
| 1Department of Knee Surgery, Firouzgar Hospital, Iran University of Medical Sciences,Tehran , Iran | ||
| 2Bone and Joint Reconstruction Research Center, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran | ||
| 3Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran | ||
| 4Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences , Isfahan, Iran - Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran | ||
| 5Iran University of Medical Sciences, Tehran, Iran | ||
| چکیده | ||
| Background: Blood loss during and immediately after total knee arthroplasty (TKA) is among the most challenging concerns. It has been demonstrated that Tranexamic acid (TXA) can help to reduce perioperative blood loss. TXA can be used as an oral, topical or intravenous injection. Many studies evaluated the effectiveness of each route of administration but few works on a comparison between them. The current study aimed to compare the effectiveness of intravenous injection versus topical use of TXA in reducing perioperative blood loss after primary total knee arthroplasty. Methods: Eighty-five patients who were a candidate for total knee arthroplasty were randomized into two groups: one group received Intravenous injection of 15 mg/kg TXA, 10 min before tourniquet inflation while the other group received 1 g diluted TXA during wound closure. The postoperative blood loss was estimated by measuring the whole drain output and also hemoglobin (HB) drops. Both groups compared based on the need for allogenic blood transfusion and also thromboembolic events. Results: Patients who received topical TXA had a higher total drain output (p <0.0001) compared to intravenous injection. The hemoglobin drop also was more in the topical group although it was marginally significant (P=0.05). Conclusion: Intravenous injection of TXA is more effective in reducing postoperative blood loss after primary TKA compared to topical administration. Level of evidence: I | ||
| کلیدواژهها | ||
| Blood loss؛ Intravenous؛ Topical؛ Total knee arthroplasty؛ Tranexamic acid | ||
| مراجع | ||
|
1. Guo P, He Z, Wang Y, Gao F, Sun W, Guo W, et al. Efficacy and safety of oral tranexamic acid in total knee arthroplasty: a systematic review and meta-analysis. Medicine. 2018; 97(18). 2. Guerreiro JP, Badaro BS, Balbino JR, Danieli MV, Queiroz AO, Cataneo DC. Application of tranexamic acid in total knee arthroplasty–prospective randomized trial. The open orthopaedics journal. 2017; 11:1049. 3. Sun Q, Li J, Chen J, Zheng C, Liu C, Jia Y. Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials. BMJ open. 2019; 9(1). 4. Marra F, Rosso F, Bruzzone M, Bonasia DE, Dettoni F, Rossi R. Use of tranexamic acid in total knee arthroplasty. Joints. 2016; 4(04):202-13. 5. Hynes M, Calder P, Scott G. The use of tranexamic acid to reduce blood loss during total knee arthroplasty. The knee. 2003; 10(4):375-7. 6. Boyle JA, Soric MM. Impact of tranexamic acid in total knee and total hip replacement. Journal of pharmacy practice. 2017; 30(1):89-93. 7. Grosso MJ, Trofa DP, Danoff JR, Hickernell TR, Murtaugh T, Lakra A, et al. Tranexamic acid increases early perioperative functional outcomes after total knee arthroplasty. Arthroplasty today. 2018; 4(1):74-7. 8. Xie J, Hu Q, Huang Z, Zhou Z, Pei F. Comparison of three routes of administration of tranexamic acid in primary unilateral total knee arthroplasty: Analysis of a national database. Thrombosis research. 2019; 173:96-101. 9. Keyhani S, Esmailiejah AA, Abbasian MR, Safdari F. Which route of tranexamic acid administration is more effective to reduce blood loss following total knee arthroplasty? Archives of Bone and Joint Surgery. 2016; 4(1):65. 10. Georgiev GP, Tanchev PP, Zheleva Z, Kinov P. Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature. Journal of orthopaedic translation. 2018; 13:7-12. 11. Adravanti P, Di Salvo E, Calafiore G, Vasta S, Ampollini A, Rosa MA. A prospective, randomized, comparative study of intravenous alone and combined intravenous and intraarticular administration of tranexamic acid in primary total knee replacement. Arthroplasty today. 2018; 4(1):85-8. 12. Han X, Gong G, Han N, Liu M. Efficacy and safety of oral compared with intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a meta-analysis. BMC musculoskeletal disorders. 2018; 19(1):430. 13. Tahmasebi MN, Bashti K, Ghorbani G, Sobhan MR. Intraarticular administration of tranexamic acid following total knee arthroplasty: a case-control study. Archives of Bone and Joint Surgery. 2014; 2(3):141. 14. 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. The Journal of arthroplasty. 2014; 29(8):1521-4. 15. Abdel MP, Chalmers BP, Taunton MJ, Pagnano MW, Trousdale RT, Sierra RJ, et al. Intravenous versus topical tranexamic acid in total knee arthroplasty: both effective in a randomized clinical trial of 640 patients. JBJS. 2018; 100(12):1023-9. 16. Jules-Elysee KM, Tseng A, Sculco TP, Baaklini LR, McLawhorn AS, Pickard AJ, et al. Comparison of topical and intravenous tranexamic acid for total knee replacement: a randomized double-blinded controlled study of effects on tranexamic acid levels and thrombogenic and inflammatory marker levels. JBJS. 2019; 101(23):2120-8. 17. Hamlin BR, DiGioia AM, Plakseychuk AY, Levison TJ. Topical versus intravenous tranexamic acid in total knee arthroplasty. The Journal of arthroplasty. 2015; 30(3):384-6. 18. 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 Surgery, Sports Traumatology, Arthroscopy. 2017; 25(11):3585-95. 19. Yazdi H, Klement MR, Hammad M, Inoue D, Xu C, Goswami K, et al. Tranexamic Acid Is Associated With Reduced Periprosthetic Joint Infection After Primary Total JointArthroplasty. The Journal of Arthroplasty 2020; 35:840–4. doi:10.1016/j.arth.2019.10.029. | ||
|
آمار تعداد مشاهده مقاله: 948 تعداد دریافت فایل اصل مقاله: 657 |
||
