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Efficacy and safety of multiple boluses of oral versus intravenous tranexamic acid at reducing blood loss after primary total knee arthroplasty without a tourniquet: A prospective randomized clinical trial
Cao G, Xie J, Huang Z, Huang Q, Chen G, Lei Y, Xu H, Pei F
Thrombosis Research. 2018;171:68-73.
Abstract
INTRODUCTION The aim of this study was to examine whether the administration of multiple boluses of oral or intravenous tranexamic acid (TXA) postoperatively were equivalent at reducing blood loss and the inflammatory and fibrinolytic responses in primary total knee arthroplasty (TKA) without a tourniquet. MATERIALS AND METHODS In this prospective, double-blinded, randomized trial, patients undergoing primary THA were randomized into either an oral or intravenous TXA group. All patients received 1 dose of 20mg/kg intravenous TXA 5-10min before skin incision. Patients in the oral TXA group then received 3 doses of 2g oral TXA at 4, 10, and 16h postoperatively, while patients in the intravenous TXA group received 3 doses of 1g intravenous TXA at 6, 12, and 18h after surgery. RESULTS There was no significant difference in the hemoglobin (Hb) or hematocrit (Hct) drop on postoperative day 1 (14.7+/-10.5 vs 14.4+/-9.6g/L, p=0.869; 0.042+/-0.032 vs 0.040+/-0.028, p=0.781) and 3 (22.6+/-10.6 vs 20.5+/-9.7g/L, p=0.300; 0.059+/-0.031 vs 0.054+/-0.031, p=0.332). No patients needed an allogeneic blood transfusion. The mean total blood loss, hidden blood loss, length of hospital stay, the level of inflammatory and fibrinolytic markers on the first and third postoperative days, and the incidence of complications were not significantly different between the two groups (p>0.05). CONCLUSION There was no difference in Hb and Hct drop, blood loss, inflammatory and fibrinolytic responses in primary TKA without a tourniquet between those who received multiple boluses of oral or intravenous TXA after surgery in current scheme.
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Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty
Gong S, Xu W, Wang R, Wang Z, Wang B, Han L, Chen G
Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the Esska. 2018
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Abstract
PURPOSE The purpose of the present study was to compare patient-specific instrumentation (PSI) with standard instrumentation (SI) in patients undergoing total knee arthroplasty (TKA). PSI is hypothesized to have advantages with respect to component alignment; number of outliers (defined as alignment > 3 degrees from the target alignment); operative time; perioperative blood loss; and length of hospital stay. This new surgical technique is expected to exhibit superior performance. METHODS A total of 23 randomized controlled trials (RCTs) involving 2058 knees that compared the clinical outcomes of TKA between PSI and SI were included in the present analysis; these RCTs were identified via a literature search of the PubMed, Embase, and Cochrane Library databases through March 1, 2018. The outcomes of interest included coronal, sagittal and axial component alignment (presented as the angle of deviation from the transcondylar line); number of outliers; operative time; perioperative blood loss; and length of hospital stay. RESULTS There was a significant difference in postoperative femoral axial alignment between PSI and SI patients (95% CI - 0.71 to - 0.21, p = 0.0004, I(2) = 48%). PSI resulted in approximately 0.4 degrees less deviation from the transcondylar line than SI. Based on our results, PSI reduced operative time by a mean of 7 min compared with SI (95% CI - 10.95 to - 3.75, p < 0.0001, I(2) = 78%). According to the included literature, PSI reduced perioperative blood loss by approximately 90 ml compared with SI (95% CI - 146.65 to - 20.18, p = 0.01, I(2) = 74%). We did not find any differences between PSI and SI with respect to any other parameters. CONCLUSIONS PSI has advantages in axial alignment of the femoral component, operative time, and perioperative blood loss relative to SI. No significant differences were found between PSI and SI with respect to alignment of the remaining components, number of outliers, or length of hospital stay. LEVEL OF EVIDENCE Therapeutic study (systematic review and meta-analysis), Level I.
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Multiple-dose intravenous tranexamic acid further reduces hidden blood loss after total hip arthroplasty: A randomized controlled trial
Lei Y, Huang Q, Huang Z, Xie J, Chen G, Pei F
The Journal of Arthroplasty. 2018;33((9):):2940-2945
Abstract
BACKGROUND The most appropriate dose of tranexamic acid in total hip arthroplasty (THA) has not been decided. This study was conducted to evaluate the clinical effects of multiple-dose intravenous tranexamic acid (IV-TXA) in THA. METHODS One hundred fifty patients were randomized to receive one dose of IV-TXA before incision, followed by 2 doses of IV-TXA (group A), or 3 doses of IV-TXA (group B), or 4 doses of IV-TXA (group C) at 3-hour intervals. The primary outcome was hidden blood loss (HBL). Other outcome measurements such as total blood loss, maximum hemoglobin (Hb) drop, postoperative lowest Hb level, fibrinolysis parameter (D-dimer), inflammatory factor (interleukin-6), transfusion rate, length of stay, and complications were also compared. RESULTS The mean HBL, total blood loss, and maximum Hb drop were significantly lower in group C than in groups B and A. Such differences were also detected between groups B and A. The postoperative lowest Hb level was significantly higher in group C. D-dimer and interleukin-6 in group C were significantly lower than in groups B and A at 24 and 48 hours postoperatively. Such differences were also significant between groups B and A. There was no significant difference in length of stay among groups. No patient underwent blood transfusion during hospitalization. No episodes of deep venous thrombosis or pulmonary embolism occurred in all cases. CONCLUSION The 5-dose IV-TXA regimen can further diminish HBL, decrease maximum Hb drop, provide additional fibrinolysis control, and ameliorate postoperative inflammatory response following THA.