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Tranexamic Acid versus Epsilon-Aminocaproic Acid in Total Knee Arthroplasty: A Meta-Analysis
Li Z, Sun X, Li W, Zhang M
Journal of healthcare engineering. 2021;2021:1758066
Abstract
OBJECTIVE At present, the effect of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) on total knee arthroplasty (TKA) remains controversial. Therefore, the aim of this meta-analysis is to compare the differences between the effects of TXA and EACA in TKA. METHODS We used electronic databases, including PubMed, Embase, MEDLINE, Ovid, ScienceDirect, Cochran Library, Google Scholar, clinical trial, and Chinese related databases, for literature search to find any effect of TXA and EACA in TKA. The differences between groups were compared by odds ratio (OR), weighted mean difference (WMD), and 95% confidence interval (CI). A total of four studies, including 3 randomized controlled trials (RCT) and 1 cohort study, were involved in this meta-analysis, involving 1836 participants. Among these participants, 816 belonged to the TXA group and 1020 belonged to the EACA group. RESULTS Meta-analysis indicated no difference in surgery time (WMD = 0.01, 95% CI -0.35 to 0.36), total amount of blood loss (WMD = 0.14, 95% CI -0.09 to 0.37), transfusion rate (OR = 0.74, 95% CI 0.20 to 2.78), transfusion units per patient (SMD = -0.15, 95% CI -0.54 to 0.25), complications (OR = 0.75, 95% CI 0.37 to 1.55), and length of stay (SMD = -0.01, 95% CI -0.11 to 0.08). CONCLUSIONS Our results suggest that the effect of TXA is not superior to EACA in TKA. However, this conclusion still needs to be further confirmed by multicenter and large-sample clinical trials.
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The efficacy and safety of multiple doses of oral tranexamic acid on blood loss, inflammatory and fibrinolysis response following total knee arthroplasty: A randomized controlled trial
Tang Y, Wen Y, Li W, Li H, Yang Y, Liu Y
International journal of surgery (London, England). 2019;65:45-51
Abstract
BACKGROUND The aim of the study was to identify the efficacy and safety of multiple doses of oral tranexamic acid (TXA) on reducing blood loss and minimizing the postoperative inflammatory and fibrinolytic responses following primary total knee arthroplasty (TKA). MATERIALS AND METHODS In this prospective, double-blinded, randomized trial, we randomly assigned a total of 151 patients into three groups to receive 2g of oral TXA 2h preoperatively (group A); an additional dose of 2g of oral TXA 4h postoperatively (group B); or additional doses of 2g of oral TXA at 4, 10, and 16h postoperatively (group C). The primary outcome was total blood loss (TBL). The secondary outcomes were maximum drop in hemoglobin (Hb) and hematocrit (Hct), level of inflammatory and fibrinolytic parameters, transfusion rate, and the incidence of complications. RESULTS The results were represented as mean+/-standard deviation. The mean TBL was 607+/-254mL in group C, 743+/-347mL in group B (p=0.027 vs group C), and 978+/-335mL in group A (p<0.001 vs group C). The maximum Hb and Hct drop was 18.3+/-7.7g/L and 0.051+/-0.025 in group C, 22.3+/-9.7g/L and 0.070+/-0.028 in group B (p=0.022 and p=0.001 vs group C), 29.6+/-11.7g/L and 0.090+/-0.034 in group A (p<0.001 and p<0.001 vs group C). In addition, C-reactive protein and interleukin-6 in group C were lower than in group A (p<0.001 and p=0.003) and in group B (p=0.031 and p<0.001) on postoperative day (POD) 3. Moreover, fibrin degradation products and D-dimer in group C were lower than in groups A and B on both POD 1 and POD 3. The incidence of complications did not differ significantly between the three groups (p>0.05). CONCLUSION Multiple postoperative doses of oral TXA could further reduced blood loss and the drop in Hb and Hct, and diminished the postoperative inflammatory and fibrinolytic responses in primary TKA with no apparent increase in the incidence of complications. LEVEL OF EVIDENCE Level , therapeutic study.
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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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4.
Safety and efficacy of tranexamic acid in total knee arthroplasty
Yu X, Li W, Xu P, Liu J, Qiu Y, Zhu Y
Medical Science Monitor.. 2015;21:3095-103.
Abstract
BACKGROUND The prevalence of total knee arthroplasty (TKA) is increasing, which is one of the most frequent operations in orthopedic practice. To further investigate the safe and effective role of using tranexamic acid (TA) in reducing transfusion rate and blood loss in total knee arthroplasty. MATERIAL AND METHODS This meta-analysis was conducted according to the Cochrane methodology. Twenty-eight superior quality and well designed randomized controlled trials (RCT) were collected to analyze for this study. Patients who had undergone primary unilateral TKA were chosen. The software, RevMan 5.2, was used to analyze collected data. RESULTS Finally, 28 RCTs were collected to analyze for this study. Total blood loss was dramatically decreased via the application of TA, by a mean of 420 ml [95% CI: -514 to -327]. A significant reduction about blood transfusion rate was also found in patients who received TA. [RD: -0.26, 95%CI: -0.33 to -0.19]. Moreover, no significant differences were found between TA and control groups in incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). CONCLUSIONS This meta-analysis demonstrates that the application of TA in TKA could decrease total blood loss and transfusion rate. On the other hand, the application of TA is not associated with high incidence of DVT or other adverse events. TA should be taken into account in routine use in primary knee arthroplasty to benefit the patients.