Objective To explore the effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release. Methods The clinical data of 44 patients with elbow joint stiffness who were treated with release surgery between March 2022 and December 2023 and met the selection criteria were retrospectively analyzed. Among them, 20 patients were given intravenous infusion of 100 mL (1 g/100 mL, once a day) of tranexamic acid solution for 3 consecutive days after surgery (group A), and 24 patients were not treated with tranexamic acid after surgery (group B). There was no significant difference in baseline data such as gender, age, side, body mass index, initial injury, and preoperative hemoglobin, visual analogue scale (VAS) score, and Mayo elbow function score (MEPS), elbow flexion and extension activity between the two groups (P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, postoperative hospital stay, VAS score before operation and at 1, 2, and 3 days after operation, MEPS score before operation, at 3 months after operation, and at last follow-up, and elbow flexion and extension activity before operation and at last follow-up were recorded and compared between the two groups. Results Both groups of patients successfully completed the operation, and there was no significant difference in operation time (P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, and postoperative hospital stay in group A were significantly less than those in group B (P<0.05). Both groups of patients were followed up 6-12 months, with an average of 8.6 months. No complications such as wound infection, elbow joint varus and varus instability or dislocation, and pulmonary embolism or other thromboembolic events occurred in either group. The VAS scores of both groups were significantly higher at 1 day and 2 days after operation than before operation (P<0.05); the VAS score of group A was significantly lower than that of group B (P<0.05). The VAS scores of both groups decreased to the preoperative level at 3 months after operation, and there was no significant difference between the two groups (P>0.05). At 3 months after operation and at last follow-up, the MEPS scores of both groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between the two groups (P>0.05). At last follow-up, the postoperative elbow flexion and extension activity of the two groups significantly increased when compared with that before operation (P<0.05); there was no significant difference in change of elbow flexion and extension activity between the two groups (P>0.05). ConclusionIntravenous tranexamic acid for 3 consecutive days after release of traumatic elbow stiffness can significantly reduce postoperative drainage volume, shorten drainage tube indwelling time and hospital stay, and relieve early postoperative pain, but it has no effect on the risk of thrombotic and embolic events and postoperative elbow function.
ObjectiveTo evaluate the efficacy and safety of a loading high-dose tranexamic acid (TXA) followed by postoperative 5 doses in total hip arthroplasty (THA) by a randomized controlled trial.MethodsSeventy-two patients who underwent primary unilateral THA between December 2017 and March 2018 were randomly divided into two groups (36 patients in each group). A single dose of 20 mg/kg TXA was administered intravenously before 5-10 minutes of operation in group A; and a single dose of 40 mg/kg TXA was administered intravenously in group B at the same time point. All patients received 5 doses of 1 g TXA at 3, 6, 12, 18, and 24 hours after the first dose. There was no significant difference in gender, age, weight, height, body mass index, disease type, and combined medical diseases between the two groups (P>0.05). Total blood loss (TBL), lowest postoperative hemoglobin (Hb) level, fibrinolysis parameters [fibrin (ogen) degradation products (FDP), D-dimer], inflammatory factors [C-reaction protein (CRP), interleukin-6 (IL-6)], adverse events (thrombosis, pulmonary embolism) were recorded and compared between groups.ResultsThe TBL was significantly lower in group B than in group A (P<0.05). Furthermore, the lowest postoperative Hb level was significantly higher in group B than in group A (P<0.05). There was no significant difference in FDP and D-dimer before operation between the two groups (P>0.05). The levels of FDP and D-dimer were significantly lower in group B than in group A at 12 and 36 hours postoperatively (P<0.05). There was no significant difference in CRP and IL-6 before operation between the two groups (P>0.05). The levels of CRP and IL-6 were significant lower in group B than in group A at 12, 24, and 36 hours postoperatively (P<0.05). There was no significant difference at 14 days (P>0.05). There were 2 patients with intramuscular venous thrombosis in group A and 1 in group B after operation, and there was no significant difference in the incidence of embolic events (P>0.05). No deep venous thrombosis or pulmonary embolism occurred in all groups.ConclusionA loading high-dose TXA followed by postoperative 5 doses can further reduce the blood loss, provide additional fibrinolysis and inflammation control in THA, without increasing the risk of embolic events.
ObjectivesTo systematically review the efficacy and safety of tranexamic acid (TXA) in reducing blood transfusion and total blood loss in patients undergoing orthopaedic trauma surgery.MethodsA systematic literature search was performed using PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases. A search for grey literature was also performed in American Academy of Orthopaedic Surgeons (AAOS) and Orthopaedic Trauma Association (OTA). The search time was up to June 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias, then meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 studies were included, including 936 patients. The pooled results indicated that TXA group was superior to the control group in blood transfusion (RR=0.75, 95%CI 0.63 to 0.89, P=0.001), the total blood loss (MD=–157.61, 95%CI –250.09 to –65.13, P=0.000 8) and the wound complications (RR=0.24, 95%CI 0.10 to 0.58, P=0.002). There was no significant difference in risk of thromboembolic events (RR=1.25, 95%CI 0.78 to 2.00, P=0.36) and the mortality (RR=0.81, 95%CI 0.40 to 1.66, P=0.57) between TXA and control group.ConclusionsTXA can effectively reduce blood transfusion, total blood loss and wound complications in patients undergoing orthopedic trauma surgery. Furthermore, TXA does not significantly increase the incidence of thromboembolic events and mortality. Due to the limited quality of included studies, more high quality studies are required to verify the above conclusions.
To investigate an effect of tranexamic acid on blood loss associated with total knee arthroplasty (TKA).Methods From June 2005 to June 2006, 102 patients (43 males, 59 females; aged 59-77 years, averaged 68 years) underwent TKA. Of the 102 patients, 59 had osteoarthritis, 23 had rheumatoid arthritis, and 20 had traumatic arthritis.The illness course ranged from 2 to 12 years. They were randomized divided into Group A and Group B of 51 patients each. The patients in Group A received tranexamic acid, and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 hours later. In Group B, only 250 ml of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 102 patients were recorded. They were also observed for whether they had deep vein thrombosis. D-dimeride, fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.Results The blood loss was 256±149 ml in Group A and 306±214 ml in Group B during operation; there was no significant difference between the two groups（P＞0.05）. The postoperative drainage volume was 478±172 ml in Group A and 814±156 ml in Group B, and the total blood loss was 559±159 ml in Group A and 1.208±243 ml in Group B; there were significant differences between the two groups (P＜0.05). The averaged amount of blood transfusion was 556±174 ml in Group A and 1 024± 278 ml in Group B; there was a significant difference between the two groups (P＜0.05). The postoperative hemoglobin concentration was higher in GroupA than that in Group B (1.0-1.1 g/dL vs. 0.6-0.8 g/dL). The ostoperative follow-up for 612 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. The level of D-dimeride was significantly higher 3 hours after operation than before operation (0.92±0.56 mg/L vs. 0.35±0.13 mg/L in Group A; 1.32±0.79 mg/L vs. 0.37± 0.21 mg/L in Group B) (P＜0.05). The D-dimeride level 3 hours after operation was significantly higher n Group B than in Group A（P＜0.05）. There were no significant differencesin the levels of fibrinogen, prothrombin time, and activated partial thromboplastin time between the two groups（P＞0.05）.Conclusion During and after the TKA operation, a shortterm use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.
ObjectiveTo explore the effect of tranexamic acid (TXA) on the transfusion rate, dominant blood loss, and postoperative complications in simultaneous bilateral total hip arthroplasty (SBTHA).MethodsA clinical data of 72 patients who underwent the primary SBTHA between January 2010 and December 2018 was retrospectively analyzed. A single dose of 15 mg/kg TXA was administered intravenously before 5-10 minutes of operation in 48 patients of trial group and 24 patients were not treated with TXA in the control group. There was no significant difference between the two groups (P>0.05) in the gender, age, body mass index, the type of disease, American Society of Anesthesiologists (ASA) grading, comorbidity, and preoperative hospital stay, hemoglobin, hematocrit, platelet count, coagulation function tests. The operation time, intraoperative blood loss, and postoperative transfusion rate, dominant blood loss, complication, and hospital stay were recorded and compared between the two groups.ResultsThe median operation time of the trial group was 208.0 minutes, and that of the control group was 202.5 minutes, with no significant difference (Z=?1.046, P=0.295). Postoperative transfusion was performed in 26 patients (54.2%) in the trial group and 21 patients (87.5%) in the control group, and the difference of transfusion rate between the two groups was significant (χ2=7.843, P=0.005). However, there was no significant difference in the amount of transfused suspended red blood cells and plasma between the two groups (P>0.05). The median intraoperative blood loss was 550 mL in the trial group and 600 mL in the control group, with no significant difference (Z=?1.378, P=0.168). The postoperative drainage volume and median dominant blood loss in the trial group were (542±269) and 1 050 mL, respectively, which were significantly lower than those in the control group [(710±316) and 1 270 mL] (P<0.05). There was 1 case of skin tension blisters around the incision, 1 case of lower limb numbness and muscle strength loss, and 1 case of lacunar cerebral infarction in the trial group, while in the control group, there was 1 case of skin ecchymosis around the incision and 1 case of bilateral lower limb numbness and muscle strength loss, which showed no significant difference in the incidences of complications (P>0.05). No pulmonary embolism or deep venous thrombosis was found in the two groups. The median postoperative hospital stay and median total hospital stay were 9.0 and 13.0 days in the trial group, while 9.0 and 13.0 days in the control group, respectively, with no significant difference (P>0.05).ConclusionFor patients who are treated with the primary SBTHA, TXA can reduce transfusion rate and perioperative dominant blood loss, and has a good hemostatic effect without increasing complications of incision, pulmonary embolism, deep venous thrombosis, and hospital stay. Therefore, TXA is relative safe.
Objective A prospective randomized controlled trial was conducted to study the effectiveness and safety of intravenous different doses tranexamic acid (TXA) in single-level unilateral minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods The patients treated with single-level unilateral MIS-TLIF between September 2019 and October 2020 were enrolled and randomly classified into low-dose TXA (LD) group (n=39), high-dose TXA (HD) group (n=39), and placebo-controlled (PC) group (n=38). The LD, HD, and PC groups received intravenous TXA 20 mg/kg, TXA 50 mg/kg, the same volume of normal saline at 30 minute before skin incision after general anesthesia, respectively. There was no significant difference on baseline characteristics and preoperative laboratory results among 3 groups (P>0.05), including age, gender, body mass index, surgical segments, hematocrit (HCT), hemoglobin (HGB), prothrombin time (PT), international normalized ratio (INR), D-dimer, fibrin degradation products (FDP), activated partial prothromboplastin time (APTT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), urea. The intraoperative blood loss (IBL), postoperative drainage volume, operation time, total blood loss (TBL), hidden blood loss (HBL), blood transfusion, hematological examination indexes on the first day after operation, and the incidence of complications within 1 month were compared among the 3 groups. Results There were 3, 2, and 4 patients in the LD, HD, and PC groups who underwent autologous blood transfusion, respectively, and there was no allogeneic blood transfusion patients in the 3 groups. There was no significant difference in IBL, postoperative drainage volume, and operation time between groups (P>0.05). The TBL, HBL, and the decreased value of HGB in LD and HD groups were significantly lower than those in PC group (P<0.05), and TBL and HBL in HD group were significantly lower than those in LD group (P<0.05); the decreased value of HGB between LD group and HD group showed no significant difference (P>0.05). On the first day after operation, D-dimer in LD and HD groups were significantly lower than that in PC group (P<0.05); there was no significant difference between LD and HD groups (P>0.05). There was no significant difference in other hematological indexes between groups (P>0.05). All patients were followed up 1 month, and there was no TXA-related complication such as deep venous thrombosis of lower extremity, pulmonary embolism, and epilepsy in the 3 groups. ConclusionIntravenous administration of TXA in single-level unilateral MIS-TLIF is effective and safe in reducing postoperative TBL and HBL within 1 day in a dose-dependent manner. Also, TXA can reduce postoperative fibrinolysis markers and do not increase the risk of thrombotic events, including deep venous thrombosis and pulmonary embolism.
ObjectiveTo analyze the reporting and methodological quality of tranexamic acid meta-analyses published in Chinese journals. MethodsThe CNKI, WanFang Data, and CBM databases were electronically searched for meta-analyses of tranexamic acid from inception to August 12th, 2021. Two reviewers independently screened literature, extracted data, and used AMSTAR 2 and PRISMA 2009 to assess the methodological and reporting quality of publications. ResultsA total of 68 meta-analyses were included. The identified meta-analyses required improvement for items 2, 3, 4, 7, 8, 10, 12, 15, and 16 in the AMSTAR 2, and items 2, 5, 8, 12, 15, 17, 22, 24, and 27 in the PRISMA 2009 assessments, respectively. The methodological and reporting quality scores were positively correlated (rs=0.36, P=0.002). Linear regression analysis identified the mentioning of PRISMA and funding support as the independent factors potentially affecting the reporting quality score (P<0.05). ConclusionsBoth the methodological and reporting quality of the tranexamic acid meta-analyses published in Chinese journals require improvement.
ObjectiveTo explore the effectiveness and safety of tranexamic acid (TXA) in anterior approach surgery for thoracolumbar fractures.MethodsFrom January 2017 to January 2020, a total of 68 thoracolumbar fracture patients undergoing anterior approach surgery were included and randomly divided into TXA group (n=33) and control group (n=35). Patients in the TXA group were given a dose of 15 mg/kg of TXA by intravenous infusion during 30 min before skin incision and an additional 15 mg/kg of TXA intravenously at 8 h after the first infusion, while the ones in the control group were given 15 mg/kg of normal saline at the same time. Basic data of the patients were collected. The hemoglobin concentration, hematocrit, coagulation and fibrinolysis indexes of the patients were monitored preoperatively, 24-hour postoperatively, and 72-hour postoperatively. The intraoperative blood loss and wound drainage of the patients were recorded. The incidence of blood transfusion and thrombotic events were collected. Statistical analysis was performed.ResultsThere was no significant difference in age, sex, body mass index, operation time, fracture location distribution, anesthesia classification of American Society of Anesthesiologists, neurologic grade of American Spinal Injury Association, injury time, or length of hospital stay between the two groups (P>0.05). Compared with those in the control group, the total blood loss [(1 398.49±312.24) vs. (1 642.30±357.78) mL, P=0.003], intraoperative blood loss [(432.83±74.76) vs. (486.31±86.51) mL, P=0.008], and wound drainage [(276.73±89.42) vs. (389.24±125.71) mL, P<0.001] in the TXA group reduced. No statistically significant difference was found between the two groups in the preoperative hemoglobin or hematocrit (P>0.05), but the 24-hour postoperative hemoglobin concentration [(112.67±20.59) vs. (102.64±19.41) g/L, P=0.042] and hematocrit [(32.25±4.12)% vs. (30.13±4.28)%, P=0.042] in the TXA group were higher than those in the control group. The incidence of allogeneic blood transfusion in the TXA group was lower than that in the control group (6.1% vs. 25.7%, P<0.05). There was no statistically significant difference in preoperative, 24-hour postoperative, or 72-hour postoperative prothrombin time, international standardized ratio, activated partial prothrombin time, platelet count, fibrinogen, d-dimer, or fibrinogen degradation products between the two groups (P>0.05), and no thrombotic complications were found.ConclusionTXA has good efficacy and safety in the anterior approach surgery for thoracolumbar fractures.
Objective
To systematically review the clinical efficiency and safety after topical administration of tranexamic acid in total hip arthroplasty.
Methods
Relevant randomized controlled trials were identified from databases such as Cochrane Library, PubMed, Embase and CNKI from the establishment of the database to August, 2017. A systematic review was performed to compare total blood loss, the rate of transfusion and thromboembolism events between the tranexamic acid group and the control group. And the patients in tranexamic acid group were treated with tranexamic acid for hemorrhage after total hip arthroplasty, while the patients in the control group were not treated with tranexamic acid or used isotonic saline. Analysis was carried out using Review Manager version 5.2.0 software.
Results
Eight studies were incorporated into the Meta-analysis. The results of Meta-analysis showed that there was significant difference in total blood loss between two groups [weighted mean difference (WMD)=–360.27 mL, 95% confidence interval (CI) (–412.68, –307.87) mL, P<0.000 01]. There was significant difference in the rate of transfusion between two groups [ (odds ratio,OR)=0.22, 95%CI (0.14, 0.33), P<0.000 01]. There was no significant difference in complications between two groups [OR=1.48, 95%CI (0.41, 5.34), P=0.55].
Conclusion
Topical administration of tranexamic acid could significantly reduce total blood loss and transfusion requirements in primary total hip arthroplasty, and would not increase thromboembolic complications.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=?12.07 min, 95%CI (?17.21, ?6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=?1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (?3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (?0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.
