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1.
Effect of Tranexamic Acid on Blood Management during a High Tibial Osteotomy: A Systematic Review and Meta-analysis
Fang Q, Zhang Z, Wang D, Wang L, Xiong W, Tang Y, Liu W, Wang G
Orthopaedic surgery. 2022
Abstract
This study aimed to evaluate the efficiency and safety of tranexamic acid for blood management during high tibial osteotomy (HTO). A systematic search was conducted in Medline, Embase, and the Cochrane library database. Six studies and 208 patients were included in this meta-analysis using Review Manager V.5.3 and Stata 15.1 software. For primary outcomes, tranexamic acid lowered the total blood loss (WMD = -219.47, 95% CI [-355.61, -83.33], P = 0.002). For secondary outcomes, a significant reduction was found for decreased hemoglobin (POD1: WMD = -9.86, 95% CI [-13.45, -6.28], P < 0.05; POD2: WMD = -8.41, 95% CI [-11.50, -5.32], P < 0.05; POD5: WMD = -11.48, 95% CI [-14.56, -8.39], P < 0.05) and drainage (total: WMD = -105.93, 95% CI [-187.08, -24.78], P < 0.05; POD1: WMD = -122.195, 95% CI [-168.902, -75.488], P < 0.05). The sex difference (male/female ratio) was determined (total blood loss: P = 0.025; total drainage amount: p = 0.018) using meta-regression analysis. Females benefited more from tranexamic acid in terms of total blood loss (M/F > 40%: WMD = -53.11, 95% CI [-100.16, -6.05], P = 0.03; 40% ≥ M/F ≥ 20%: WMD = -362.20, 95% CI [-423.96, -300.45], P < 0.05; M/F < 20%: WMD = -263.00, 95% CI [-277.17, -248.83], P < 0.05) and total drainage (M/F > 40%: WMD = -7.11, 95% CI [-10.75, -3.47], P < 0.05; 40% ≥ M/F ≥ 20%: WMD = -104.72, 95% CI [-155.36, -54.08], P < 0.05; M/F < 20%: WMD = -222.00, 95% CI [-297.42, -146.58], P < 0.05). No significant differences were found for drainage on POD2 and POD3, wound complications, orthromboembolic events. In conclusion, tranexamic acid is effective and safe for blood management during HTO. Females appeared to benefit more from it, and an additional postoperative dose is suggested fora better effect.
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2.
Controlled Hypotension Combined with Femoral Nerve Block for Knee Replacement without Tourniquet
Wang L, Zheng Y, Zhang X, Ke Q
Journal of healthcare engineering. 2021;2021:3219337
Abstract
In the process of knee replacement surgery, the use of tourniquet technology for hemostasis is the most common method. But the adverse reactions of tourniquets in knee replacement surgery have become more prominent in recent years. More and more scholars have begun to advocate the optimization of the use of tourniquet technology, thereby controlling the use of tourniquet technology. In this study, 125 patient cases were randomly divided into four experimental groups for comparative analysis. The two sets of variables are whether to use tourniquet during surgery and use intravenous analgesia or nerve block analgesia. Studies have shown that when using a tourniquet for knee replacement surgery, the chance of hidden blood loss increases after use. The tourniquet was not used during the operation, the patient's thighs were swollen, and postoperative pain was reduced. Compared with intravenous analgesia, knee joint replacement with uncontrolled tourniquet combined with femoral nerve block has a better analgesic effect and can effectively relieve pain after knee replacement. Therefore, under the method of controlled hypotension combined with femoral nerve block, TKA surgery without using tourniquet technology is more conducive to early health recovery and pain relief after TKA surgery, as well as functional exercise and knee joint recovery during postoperative recovery.
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3.
Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion
Li J, Wang L, Bai T, Liu Y, Huang Y
Journal of orthopaedic surgery and research. 2020;15(1):339
Abstract
PURPOSE The current study was conducted to assess the efficacy and safety of the intravenous (IV) administration combined with topical administration of tranexamic acid (TXA)in patients (aged over 60) scheduled for a 2-level lumbar fusion surgery. METHODS Two hundred eighty patients scheduled for a 2-level lumbar fusion surgery were randomized into four groups, including an IV group, a local group, a combined group, and a control group. Patients in the combined group, in the IV group, in the topical group, and in the control group were administrated with 15 mg/kg of IV-TXA + 2 g TXA in local, 15 mg/kg IV-TXA, 2 g TXA in local, and 100 ml IV, respectively. The results of total blood loss (TBL), maximum hemoglobin drop, the transfusion rate, and the number of allogeneic blood units were compared. Deep venous thrombosis (DVT) and pulmonary embolism (PE) events were monitored and recorded. RESULTS The TBL was 635.49 ± 143.60, 892.62 ± 166.85, 901.11 ± 186.25, and 1225.11 ± 186.25 mL for the combined group, the IV group, the topical group, and the control group, respectively (p = 0.015, p = 0.001, respectively). The average maximum hemoglobin drop in the four above groups was 2.18 ± 0.24, 2.80 ± 0.37, 2.40 ± 0.64, and 3.40 ± 1.32 g/dL, respectively. No PE event was reported during the follow-up. Although asymptomatic DVT events were reported by 1, 2, and 2 patients in the combined group, topical group, and control group, respectively, there is no intergroup difference. CONCLUSIONS The combined use of TXA effectively reduced the total blood loss and blood transfusion rate in patients aged over 60 scheduled for a 2-level lumbar fusion, without increasing the incidence of DVT and PE formation.
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4.
Effect of tranexamic acid on symptomatic venous thromboembolism in patients undergoing primary total knee arthroplasty
Peng H, Wang L, Weng X, Zhai J, Lin J, Jin J, Qian W, Gao N
Arch Med Sci. 2020;16(3):603-612
Abstract
Introduction: This study aimed to investigate the effect of tranexamic acid (TXA) with sequential routine anticoagulation on postoperative symptomatic venous thromboembolism (VTE) in patients undergoing primary total knee arthroplasty (TKA). Material and methods: This was a prospective study with randomized trials. From January 2013 to May 2015, 1880 patients undergoing primary TKA were enrolled in this study. Seven hundred and twenty patients who received TXA injection were included in the TXA group while 1160 patients who received placebo injection were included in the control group. Patients in the TXA group were treated with intravenous TXA or topical intravenous TXA, and all received sequential routine anticoagulation 12 h after the operation. We extracted data of patients' sex, age, primary diagnoses, and comorbidities that could potentially affect the prevalence rate of VTE. To discuss the risk factors of symbolic VTE, comparisons were made within the TXA group between patients with symbolic VTE and non-symbolic VTE. Logistic regression analysis was performed to analyze the concurrent effects of various factors on the prevalence rate of postoperative VTE. Results: Thigh perimeter was not closely associated with TXA injection. Within the TXA group, 24 (3.3%) patients had perioperative symptomatic VTE, 16 (2.2%) deep vein thrombosis (DVT) and 8 (1.1%) pulmonary embolism. High body mass index (BMI), low fibrinogen (Fbg) and simultaneous bilateral TKA were significant risk factors in both univariate analysis and multivariate analysis. Conclusions: Increased BMI, low Fbg, and simultaneous bilateral TKA could act as risk factors for postoperative symptomatic VTE treated with TXA.
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5.
Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial
Wang HY, Wang L, Luo ZY, Wang D, Tang X, Zhou ZK, Pei FX
BMC musculoskeletal disorders. 2019;20(1):478
Abstract
BACKGROUND To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. METHODS In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. RESULTS The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. CONCLUSION Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. TRIAL REGISTRATION The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR-IPR-17012264 ).
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6.
[Effect of transcutaneous electrical acupoint stimulation on pulmonary function and oxidative stress response in lower extremity surgery patients using tourniquet]
Zhuang XX, Yang LL, Wang L, Mo YC, Pan YY, Dai QX, Lu Y, Wang JL
Zhen ci yan jiu = Acupuncture research. 2019;44(8):594-8
Abstract
OBJECTIVE To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on pulmonary function, superoxide dismutase (SOD) activity, and malondialdehyde (MDA) content in patients using tourniquet after lower extremity surgery. METHODS A total of 40 patients who underwent lower extremity surgery were equally randomized into control group and TEAS group by using a random number table. All patients underwent lumbar epidural anesthesia combined with block anesthesia. The patients in the TEAS group were given TEAS at Zusanli (ST36) and Sanyinjiao (SP6) beginning from 30 min before surgery to the end of surgery, and those in the control group received TEAS at the same acupoints with minimum current intensity. Mean arterial pressure (MAP) and heart rate (HR) were recorded at each time point (T0: pre-surgery /TEAS, T1: 5 min after anesthesia, T2: 1 min before tourniquet-loosening, T3: 1 min after tourniquet-loosening, T4: 5 min after tourniquet-loosening, and T5: 6 h after tourniquet-loosening). Blood samples (4 mL) was collected from the radial artery before TEAS and 6 h after loosening tourniquet for analyzing blood gas parameters as partial pressure of caron dioxide(PCO2), arterial partial pressure of oxygen (PaO2), alveolar partial pressure of oxygen (PAO2), alveolar-arterial oxygen pressure difference (PA-aDO2) and respiratory index (RI) by using a blood gas analyzer, and plasma SOD activity and MDA content were assayed by using xanthine oxidase method and thiobarbituric acid colorimetry method, respectively. RESULTS Intra-group comparison showed that compared with T0, a significant increase was found in PA-aDO2 and RI at T5 and a significant reduction in PaO2 and PaO2/ PAO2 (a/A) ratio in the control group (P<0.05), and the same changes in the TEAS group (P<0.05) except a/A ratio. Comparison between two groups showed that at T5, both PaO2 and a/A levels were significantly higher in the TEAS group than in the control group (P<0.05), and both PA-aDO2 and RI levels were obviously lower in the TEAS group than in the control group (P<0.05), suggesting an improvement of the pulmonary function after TEAS. At T5, plasma SOD activity was significantly decreased and plasma MDA content was remarkably increased in the control group relevant to T0 (P<0.05), SOD activity was significantly higher in the TEAS group than in the control group (P<0.05), and MDA content was evidently lower in the TEAS group than in the control group (P<0.05), suggesting a reduction of oxidative stress response after TEAS. CONCLUSION TEAS at ST36 and SP6 can improve pulmonary function and attenuate oxidative stress response in patients using tourniquet after lower extremity surgery.
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7.
Comparison between oral and intravenous application of tranexamic acid for total hip arthroplasty: a meta-analysis
Wang L, Cao JG, Liu J
Journal of comparative effectiveness research. 2019
Abstract
AIM: We conducted a meta-analysis to compare the efficacy and safety of oral and intravenous applications of tranexamic acid (TXA) in total hip arthroplasty (THA). MATERIALS & METHODS Electronic databases, including PubMed, Cochrane CENTRAL, ScienceDirect and Embase, were searched to identify the studies comparing the efficacy and safety of oral and intravenous applications of TXA in THA. Relevant journals and conference proceedings were manually searched. The pooled data were analyzed using RevMan 5.1. RESULTS Four randomized control trials and one retrospective study were identified. A meta-analysis showed no significant differences in hemoglobin reduction, total blood loss and transfusion requirements. CONCLUSION Oral applications of TXA are comparable to intravenous applications of TXA in primary unilateral THA for blood conservation and cost-saving measures.
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8.
Platelet-Rich Plasma-Incorporated Autologous Granular Bone Grafts Improve Outcomes of Post-Traumatic Osteonecrosis of the Femoral Head
Xian H, Luo D, Wang L, Cheng W, Zhai W, Lian K, Lin D
The Journal of arthroplasty. 2019
Abstract
BACKGROUND To investigate the effects of platelet-rich plasma (PRP)-incorporated autologous granular bone grafts for treatment in the precollapse stages (Association of Research Circulation Osseous stage II-III) of posttraumatic osteonecrosis of the femoral head. METHODS A total of 46 patients were eligible and enrolled in the study. Twenty-four patients were treated with core decompression and PRP-incorporated autologous granular bone grafting (treatment group), and 22 patients were treated with core decompression and autologous granular bone grafting (control group). During a minimum follow-up duration of 36 months, X-ray and computed tomography were used to evaluate the radiological results, and the Harris hip score (HHS) and visual analog scale were chosen to assess the clinical results. RESULTS Both the treatment and control groups had a significantly improved HHS (P < .001). The minimum clinically important difference for the HHS was reached in 91.7% of the treatment group and 68.2% of the control group (P < .05). The HHS and visual analog scale in the treatment group were significantly improved than that in the control group at the last follow-up (P < .05). Successful clinical and radiological results were achieved 87.5% and 79.2% in the treatment group compared with 59.1% and 50.0% in the control group (P < .05), respectively. The survival rates based on the requirement for further hip surgery as an endpoint were higher in the treatment group in comparison to those in the control group (P < .05). CONCLUSION PRP-incorporated autologous granular bone grafting is a safe and effective procedure for treatment in the precollapse stages (Association of Research Circulation Osseous stage II-III) of posttraumatic osteonecrosis of the femoral head.
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9.
Tranexamic acid treatment decreases hidden blood loss in total knee arthroplasty
Chen X, Zhu X, Yang S, Lin W, Wang L
American Journal of Therapeutics.. 2016;23((6)):e1397-e1405.
Abstract
The aim of our meta-analysis is to investigate the effect of tranexamic acid (TXA) on hidden blood loss (HBL) in total knee arthroplasty (TKA). A literature search was undertaken to identify all cohort studies that investigated the effect of TXA on HBL in TKA. Both electronic database search and manual search were used to retrieve studies related to the topic, and the retrieved studies were screened according to our stringent inclusion and exclusion criteria. Comprehensive Meta-analysis 2.0 software (CMA 2.0) was used for statistical analysis of the data retrieved from selected case-cohort studies. A total of 480 studies were initially retrieved, and after further screening and selection, 7 studies were eventually incorporated into our meta-analysis. The 7 studies included a total of 530 osteoarthritis or rheumatic arthritis patients who had TKA, and among them, 250 patients received an intravenous injection of TXA as cases and 280 patients received an intravenous injection of sodium chloride as sterile placebo controls. Our meta-analysis revealed that the volume of HBL of cases was lower than that of controls, which was statistically significant. The ethnicity-stratified analysis suggested that the volume of HBL of cases was significantly lower than that of controls in both the Asians and whites, also at statistically significant levels. Our meta-analysis provides strong evidence that TXA significantly reduces HBL in TKA, thus TXA can be used as a standard drug to prevent/reduce HBL in TKA. RN 0 (Antifibrinolytic Agents). 6T84R30KC1 (Tranexamic Acid).
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10.
The use of clamped drainage to reduce blood loss in total hip arthroplasty
Cao JG, Wang L, Liu J
Journal of Orthopaedic Surgery.. 2015;10((1):):130
Abstract
BACKGROUND Drainage is a routine practice used to reduce hematoma and blood loss following total hip arthroplasty. The aim of this study was to assess the effect of clamped drainage on blood loss and wound healing after total hip arthroplasty. METHODS A prospective cohort of 44 patients with hip osteoarthritis or femur head necrosis undergoing total hip arthroplasty was randomized equally into two groups: 6-h postoperative clamped or non-clamped suction tube drainage. Body mass index, gender distribution, preoperative hemoglobin, hip pathology, and affected side were comparable between the two groups. Blood loss, hemoglobin levels, and wound healing complications were recorded and compared between groups. RESULTS The drainage blood loss and calculated blood loss volumes were higher for the non-clamped group. About 100 mL more blood loss was noticed in the non-clamped group. There was no significant difference in adverse events or need for transfusion. CONCLUSIONS The present study showed a statistically significant reduction in postoperative drainage amount between clamped and unclamped drainage groups, but this difference was not large enough to warrant increased blood transfusion requirements in patients with unclamped drainage. Further studies are essential to define the critical period of clamping that is compatible with the dual objectives of reduced blood loss and lack of wound complications from hematoma.