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1.
The Application of Platelet-Rich Plasma for Patients Following Total Joint Replacement: A Meta-Analysis of Randomized Controlled Trials and Systematic Review
Shu H, Huang Z, Bai X, Xia Z, Wang N, Fu X, Cheng X, Zhou B
Frontiers in surgery. 2022;9:922637
Abstract
BACKGROUND The clinical efficacy of platelet-rich plasma (PRP) in the treatment of total joint replacement (TJR) remains inconclusive. In this paper, systematic review and meta-analysis was adopted to assess the efficacy of using PRP for the treatment of TJR. METHODS A comprehensive search of Medline, Embase, and Cochrane library databases for randomized controlled trial (RCT) articles recording data of PRP for TJR was conducted from inception to February 2022. Outcomes concerned were pain, range of motion (ROM), WOMAC score, length of hospital stay (LOS), hemoglobin (Hb) drop, total blood loss, wound healing rate, and wound infection. The methodological quality of the included RCTs was evaluated by using the Cochrane Risk of Bias Tool 2.0 (RoB 2.0). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was utilized to assess the level of evidence for the outcomes. Subgroup analysis was conducted according to the type of TJR. RESULTS Ten RCTs were included in the meta-analysis. In the TKA subgroup, the available data demonstrated that there were significant differences in the outcomes of pain and Hb drop, while it was the opposite of ROM, WOMAC score, LOS, total blood loss, wound healing rate, and wound infection. In the THA subgroup, no significant differences could be seen between two groups in the outcomes of LOS and wound infection. However, the PRP group gained a higher wound healing rate in the THA subgroup. CONCLUSION The application of PRP did not reduce blood loss but improved the wound healing rate. However, more prospective and multicenter studies are warranted to confirm these results.
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2.
Tranexamic acid combined with compression dressing reduces blood loss in gluteal muscle contracture surgery
Ma J, Huang Z, Huang Q, Zhou Z, Pei F, Shen B
BMC surgery. 2022;22(1):46
Abstract
BACKGROUND Blood loss and incision-related complications caused by the surgical procedure to release gluteal muscle contracture (GMC) put negative effects on the surgical outcomes. Current procedures to prevent blood loss and complications are not satisfactory. The current study aimed to determine whether tranexamic acid (TXA) in combination with pressure dressing reduce the amount of blood loss, the rate of incision-related complications, and the rate of readmission for patients undergoing surgeries to release GMC. METHODS 49 GMC patients were finally included in the study and were randomly divided into two groups: study group and control group. Patients in both groups received minimally invasive surgery to release GMC except that in the study group, patients were administered a dosage of 20 mg/kg of intravenous TXA preoperatively, and 2 subsequent dosages of TXA at 10 mg/kg at two time points: 3 and 6 h after the first dose. Gauze soaked with TXA was used to pack the wound for 10 min before the incision closure. Then the wound was pressure-wrapped with a hip-spica bandage for 24 h after the surgery in the study group. RESULTS The level of UBL in the study group was significantly lower compared to that in the control group. Similar results were also found for UMHD and UMAD. The incision-related postoperative complications were greatly decreased in the study group compared to those of the control group as well. So was the 30-day readmission rate. All patients in both groups reached "excellent" or "good" level with respect to the postoperative function evaluation. CONCLUSIONS Intravenous and topical application of TXA combined with 24 h pressure hip-spica bandage reduces perioperative blood loss, rate of incision-related complications, and the rate of readmission for GMC patients undergoing minimally invasive surgical releasing procedure. Trial Registration Chinese Clinical and Trial Registry ChiCTR2000039216, registration date 2020/10/22, retrospectively registered.
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3.
Synergistic Effect of a Prolonged Combination Course of Tranexamic Acid and Dexamethasone Involving High Initial Doses in Total Knee Arthroplasty: A Randomized Controlled Trial
Xu H, Xie J, Yang J, Huang Z, Wang D, Pei F
The journal of knee surgery. 2021
Abstract
The optimal regimes of tranexamic acid (TXA) and dexamethasone (DXM) in total knee arthroplasty (TKA) are still uncertain. The aim of this study was to assess the efficacy and safety of a prolonged course of intravenous TXA and DXM involving a high initial dose in TKA. Patients who underwent primary TKA at our center were randomized to receive one of four regimes: control (group A), prolonged course of TXA (B), prolonged course of DXM (C), or the combination of a prolonged course of TXA and DXM (D). The four groups were compared in primary outcomes (fibrinolytic and inflammatory markers, knee function, postoperative pain levels, and consumption of opioids) and secondary outcomes (blood loss, maximal drop in hemoglobin, coagulation, fasting blood glucose, and complications). A total of 162 patients were enrolled. On postoperative days 2 and 3, fibrinolytic markers were lower in groups B and D than in groups A and C; inflammatory markers were lower in groups C and D than in groups A and B. Inflammatory markers were lower in group B than in group A on postoperative day 3. Postoperative pain levels and oxycodone consumption were lower, and knee function was better in groups C and D. The four groups did not differ in any of the secondary outcomes. A prolonged course of intravenous TXA and DXM involving high initial doses can effectively inhibit postoperative fibrinolytic and inflammatory responses, reduce pain, and improve knee function after TKA.
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4.
The effect of oral versus intravenous tranexamic acid in reducing blood loss after primary total hip arthroplasty: A randomized clinical trial
Cao G, Huang Z, Xie J, Huang Q, Xu B, Zhang S, Pei F
Thrombosis Research. 2018;164:48-53.
Abstract
BACKGROUND The purpose of this study was to determine whether the administration of multiple boluses of oral and intravenous tranexamic acid (TXA) postoperatively was equivalent in reducing blood loss in primary THA. METHODS A total of 108 patients were randomized into two groups: oral TXA group (54 patients receiving 1 dose of 20mg/kg intravenous TXA 5-10min before skin incision and 3 doses of 2g oral TXA 4h, 10h and 16h postoperatively) and intravenous TXA group (54 patients receiving 1 dose of 20mg/kg intravenous TXA 5-10min before skin incision and 3 doses of 1g intravenous TXA 6h, 12h and 18h postoperatively). The primary outcomes were total blood loss, hidden blood loss, length of hospital stay, hemoglobin (Hb) and hematocrit (Hct) drop. The secondary outcomes were the level of inflammation markers and complications. RESULTS There was no difference in the mean total blood loss or hidden blood loss [728.4 (645.8-806.9) mL vs 703.6 (576.9-832.8) mL, p=0.745; 634.6 (552.0-715.7) mL vs 606.4 (480.1-734.5) mL, p=0.710] and length of hospital stay was similar between the two groups. No patients received allogenic blood transfusion. The Hb and Hct drop on the first and second postoperative days were similar (p>0.05). The level of inflammation markers did not reach statistical significance. The incidence of complications did not differ significantly between the two groups. CONCLUSIONS Multiple boluses of oral TXA and intravenous TXA postoperatively are equivalent in reducing blood loss, Hb and Hct drop in primary THA without increasing the risk of thromboembolic diseases and wound complications.
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5.
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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6.
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.
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7.
Intravenous and topical tranexamic acid alone are superior to tourniquet use for primary total knee arthroplasty: a prospective, randomized controlled trial
Huang Z, Xie X, Li L, Huang Q, Ma J, Shen B, Kraus VB, Pei F
The Journal of Bone and Joint Surgery. American Volume. 2017;99((24)):2053-2061.
Abstract
BACKGROUND Tourniquet use during primary total knee arthroplasty is thought to reduce intraoperative blood loss and improve visibility. Our goal was to investigate whether tourniquet use is necessary for controlling intraoperative blood loss when alternatives such as tranexamic acid (TXA) are available. METHODS One hundred and fifty patients were equally randomized to 3 groups. Group A was treated with a tourniquet as well as multiple doses of intravenous TXA (20 mg/kg 5 to 10 minutes before the skin incision and 10 mg/kg 3, 6, 12, and 24 hours later) along with 1 g of topical TXA, Group B was treated the same as Group A but without the tourniquet, and Group C was treated with the tourniquet only. RESULTS The amount of intraoperative blood loss was similar for the 3 groups. Group B had significantly less hidden blood loss than Group A (p = 0.018) and Group C (p < 0.001). No significant differences (p > 0.05) were observed between Group A and Group B with regard to total blood loss, drainage volume, intraoperative blood loss, transfusion rate, or maximum change in the hemoglobin (Hb) level. We also found significantly more benefits for Group B compared with Groups A and C with regard to postoperative swelling ratio, levels of inflammatory biomarkers, visual analog scale (VAS) pain scores, range of motion at discharge, Hospital for Special Surgery (HSS) score, and patient satisfaction. There were no significant differences (p > 0.05) in the deep venous thrombosis or pulmonary embolus rates among the 3 groups. More wound secretion was observed in the groups in which a tourniquet was used. CONCLUSIONS Patients treated with multiple doses of intravenous and topical TXA without a tourniquet had less hidden blood loss, a lower ratio of postoperative knee swelling, less postoperative knee pain, lower levels of inflammatory biomarkers, better early knee function, and even better early satisfaction than those treated with a tourniquet. Long-term follow-up should be performed to evaluate the effects on prosthetic fixation and long-term survival of total knee arthroplasty performed without a tourniquet. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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8.
A prospective randomized self-controlled study on effect of tranexamic acid in reducing blood loss in total knee arthroplasty . Chinese
Huang Z, Zhang W, Li W, Bai G, Zhang C, Lin J
Chung-Kuo Hsiu Fu Chung Chien Wai Ko Tsa Chih/Chinese Journal of Reparative & Reconstructive Surgery. 2015;29((3)):280-3.
Abstract
OBJECTIVE To investigate the safety and efficiency of intravenous tranexamic acid (TXA) to reduce blood loss in total knee arthroplasty (TKA). METHODS A prospective, randomized, self-controlled study was carried out on 60 patients scheduled for bilateral TKA between January 2012 and December 2013. TXA (10 mg/kg) was injected intravenously approximately 10 minutes before tourniquet release when TKA was performed on one side (TXA group), and TXA was not used on the other side (control group). No significant difference was found in the preoperative hemoglobin (Hgb), platelet (PLT) count, prothrombin time (PT), and activated partial thromboplastin time (APTT) between 2 groups (P > 0.05). The amount of drainage, the total blood loss, the hidden blood loss, the postoperative Hgb, the amount of blood transfusion, the ratio of blood transfusion, and the incidence of vein thrombosis embolism (VTE) were compared between 2 groups. RESULTS The amount of drainage and total blood loss were significantly less in the TXA group than in control group (P < 0.05), and the Hgb was significantly lower in the control group than in the TXA group at 6 hours, 1, 3, and 7 days after operation (P < 0.05). There was no significant difference in the hidden blood loss between 2 groups (t = 1.157, P = 0.252). The ratio of blood transfusion was significantly less in TXA group (6.7%, 4/60) than in control group (21.7%, 13/60)(P = 0.034). The total amount of blood transfusion was 14 units in TXA group, which was significantly less than that of control group (38 units) (P = 0.004). Deep vein thrombosis occurred in 3 cases in 2 groups respectively, showing no significant difference (P = 1.000). There was no symptomatic pulmonary embolism. All patients were followed up for 8-17 months, with an average of 13.7 months. No new VTE case was found during the follow-up period. CONCLUSION Intravenous injection of TXA (10 mg/kg) at 10 minutes before tourniquet release in TKA is effective in reducing perioperative blood loss, amount of blood transfusion, and ratio of transfusion, and it will not increase the risk of VTE.
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9.
Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial
Huang Z, Ma J, Shen B, Pei F
Journal of Arthroplasty. 2014;29((12):):2342-6.
Abstract
This study was aimed to determine the efficacy and safety of combined intravenous (IV) and topical application of tranexamic acid (TXA) in unilateral total knee arthroplasty (TKA) compared with the IV-TXA. One hundred eight-four patients were enrolled. Participants received either 3g of IV-TXA or 1.5g topical TXA combined with 1.5g IV-TXA. The results revealed that compared with the 3g IV-TXA, adding 1.5g topical TXA to 1.5g IV-TXA in unilateral TKA can have the similar effectiveness in reducing transfusion rate and total blood loss without sacrificing safety. The most important is that by adding topical TXA, patients can gain a smaller maximum decline of hemoglobin (Hb), less drainage volume, less postoperative knee pain, less knee swelling, shorter length of hospital stays and higher short-term satisfaction. Copyright 2014 Elsevier Inc. All rights reserved.