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1.
Tourniquets can further reduce perioperative blood loss in patients on dexamethasone and tranexamic acid during cemented total knee arthritis: a single-center, double-blind, randomized controlled trial
Jiang W, Wang X, Xu H, Liu M, Xie J, Huang Q, Zhou R, Zhou Z, Pei F
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology. 2023;24(1):17
Abstract
BACKGROUND Multiple doses of dexamethasone and tranexamic acid can inhibit postoperative inflammation and reduce fibrinolysis and perioperative blood loss in total knee arthroplasty. In this single-center, double-blind, randomized clinical trial, the aim was to investigate whether applying a tourniquet to patients on dexamethasone and tranexamic acid could further reduce perioperative blood loss. MATERIALS AND METHODS Patients who underwent cemented total knee arthroplasty at our hospital were randomized to receive a tourniquet (n = 71) or not (n = 70) during the procedure. All patients received multiple doses of dexamethasone and tranexamic acid perioperatively. The primary outcome was perioperative blood loss, while secondary outcomes were surgery duration, postoperative laboratory indices of inflammation and fibrinolysis, range of knee motion, VAS pain score, knee circumference, knee swelling rate, homologous transfusion, albumin use, and complications. RESULTS Using a tourniquet was associated with significantly lower intraoperative blood loss (P < 0.001) and total blood loss (P = 0.007) as well as significantly shorter surgery duration (P < 0.001). In contrast, the tourniquet did not significantly affect hidden blood loss, postoperative inflammation or fibrinolysis, range of knee motion, VAS pain score, knee circumference, knee swelling rate, homologous transfusion, albumin use, or complications. CONCLUSIONS The results of this randomized clinical trial demonstrate that applying a tourniquet during cemented total knee arthroplasty to patients receiving multiple doses of dexamethasone and tranexamic acid can further reduce perioperative blood loss without increasing the risk of inflammation, fibrinolysis, or other complications. Thus, it is advised to use tourniquets combined with dexamethasone and tranexamic acid to reduce perioperative blood loss and avoid tourniquet-related adverse events. LEVEL OF EVIDENCE Therapeutic Level I. Trial registration Chinese Clinical Trail Registry, ChiCTR2200060567. Registered 5 June 2022-retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=171291.
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2.
Effect of Oral Tranexamic Acid on the Blood Transfusion Rate and the Incidence of Deep Vein Thromboembolism in Patients after TKA
Chen B, Qu X, Fang X, Wang X, Ke G
Evidence-based complementary and alternative medicine : eCAM. 2022;2022:6041827
Abstract
PURPOSE To explore the effect of oral tranexamic acid treatment on the blood transfusion rate and the incidence of deep vein thromboembolism after total knee arthroplasty (TKA). METHODS 90 patients undergoing TKA admitted to First People's Hospital of Changshu City from January 2019 to January 2020 were selected and randomized into the control group and the experimental group accordingly (45 cases in each group). The control group intravenously received 20 mL/kg tranexamic acid before the incision was closed. The experimental group was given 1 g of tranexamic acid orally before anesthesia, 6 h and 12 h after the operation. RESULTS The experimental group witnessed better perioperative indexes in relation to the control group. The experimental group displayed better postoperative coagulation function indexes as compared to the control group (P < 0.05). Remarkably lower postoperative vascular endothelial function indexes in the experimental group than in the control group were observed. The experimental group experienced a markedly lower incidence of deep vein thromboembolism in comparison with the control group (P < 0.05). The postoperative knee society score (KSS) score of the experimental group was significantly higher than that of the control group. A significantly higher postoperative modified rivermead mobility index (MRMI) score was yielded in the experimental group in contrast to the control group (P < 0.05). The experimental group obtained lower numerical rating scale (NRS) scores at T2 and T3 as compared to the control group. CONCLUSION Oral tranexamic acid is a suitable alternative for patients undergoing TKA in terms of reducing the blood transfusion rate, relieving pain, and accelerating the recovery of the patient's limbs.
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3.
The efficacy and safety of tranexamic acid in the treatment of intertrochanteric fracture: an updated meta-analysis of 11 randomized controlled trials
Yu X, Wang J, Wang X, Xie L, Chen C, Zheng W
Journal of thrombosis and thrombolysis. 2020
Abstract
This meta-analysis was performed to investigate the efficacy and safety of tranexamic acid (TXA) in the elderly patients undergoing intertrochanteric fracture surgery from the current literatures. The electronic literature database of PubMed, Embase and Cochrane library were searched in October 2019. The intraoperative blood loss, hidden blood loss, postoperative drainage and total blood loss, postoperative hemoglobin, length of stay, transfusion rate, mortality rate, thromboembolic events and wound complications were extracted. Stata 14.0 software was used for our meta-analysis. A total of 11 RCTs (3 new RCTs in 2019) with 1202 patients met our inclusion criteria. This meta-analysis showed that administration of TXA can reduce intraoperative blood loss (P = 0.009), hidden blood loss (P = 0.000), total blood loss (P = 0.000), length of stay (P = 0.003), transfusion rate (P = 0.000) and the occurrence of wound complications (P = 0.006). Furthermore, administration of TXA was associated with an increase in the postoperative Hb level at day 1, 2 and 3 (P = 0.000, P = 0.000 and P = 0.000, respectively) after surgery. However, no significant difference was found between the TXA group and control group regarding the occurrence of thromboembolic events (P = 0.978, including deep vein thrombosis, P = 0.850; pulmonary embolism, P = 0.788; cerebrovascular accident, P = 0.549; myocardial infarction, P = 0.395) and mortality rate (P = 0. 338). Our meta-analysis suggested that administration of TXA is effective in reducing intraoperative blood loss, hidden blood loss, total blood loss, length of stay, transfusion rate, wound complications and enhancing postoperative Hb without increasing the risk of thromboembolic events and mortality rate in intertrochanteric fracture surgery. More large multi-center and high-quality RCTs are required for further research.
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4.
Is bipolar sealer superior than standard electrocautery for blood loss control after primary total knee arthroplasty: A meta-analysis
Chen X, Yang W, Wang X
Medicine. 2019;98(46):e17762
Abstract
BACKGROUND Whether bipolar sealer (BS) is superior to standard electrocautery in patients with primary total knee arthroplasty (TKA) remains controversial. Thus, we conducted this meta-analysis involving comparative studies (S) to evaluate whether administration with BS (I) was associated with less blood loss (O) than standard electrocautery (C) after primary TKA (P). METHODS PubMed (1950-January 2017), EMBASE (1974-January 2017), the Cochrane Library (January 2017 Issue 3), and the Google database (1950-January 2017) were systematically searched. Studies were included in accordance with Population, Intervention, Comparison, Outcomes, and Setting including criteria. Only the patients prepared for primary TKA and administrated with BS as the intervention group and standard electrocautery as control group were included in this meta-analysis. Outcomes include need for transfusion, total blood loss, blood loss in drainage, hemoglobin at discharge, hemoglobin drop, and length of hospital stay. Continuous outcomes and discontinuous outcomes were expressed as weighted mean difference (WMD) and risk ratio (RR) with corresponding confidence intervals (CIs), respectively. Stata 13.0 software was used for relevant data calculation. RESULTS A total of 7 clinical trials with 718 patients (398 patients in BS group and 320 in standard electrocautery group) were finally included in this meta-analysis. The pooled results indicated that administration with BS was associated with little reduction of total blood loss (WMD = -123.80, 95%CI -236.56 to -11.04, P = .031). There was no significant difference between the need for transfusion, blood loss in drainage, hemoglobin at discharge, hemoglobin drop, and length of hospital stay (P > .05). CONCLUSION Based on the current meta-analysis, we found no evidence to support the routine use of bipolar sealer in the management of blood loss in primary TKA. Since the poor quality of the included studies, more randomized controlled trials are still needed to further identify the efficacy of BS after primary TKA.
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5.
Different Effects of Intravenous, Topical and Combined Application of Tranexamic Acid on Patients with Thoracolumbar Fracture
Wang X, Yang R, Sun H, Zhang Y
World neurosurgery. 2019
Abstract
OBJECTIVE To observe the efficacy of intravenous, topical and combined application of tranexamic acid (TXA) in patients with thoracolumbar fracture fixed with percutaneous pedicle screw, and to identify the optimal application method of TXA. METHODS A total of 181 thoracolumbar fracture patients treated with percutaneous pedicle screw fixation were enrolled in the current randomized controlled clinical trial, and were randomly classified as three groups, including group A (intravenous group), group B (topical group), and group C (combined group). At the same time, the total blood loss (TBL), hidden blood loss (HBL), intraoperative blood loss (IBL), preoperative d-dimer, postoperative d-dimer, incidence of deep vein thrombosis (DVT) and other complications were compared and analyzed among these three groups. RESULTS TBL, HBL and IBL in topical group 24 h after operation were higher (P<0.05) than those in intravenous group and combined group, while the difference between intravenous group and combined group was not statistically significant. Meanwhile, there was no statistically significant difference in operation time, preoperative d-dimer and postoperative d-dimer among these three groups (P>0.05), but d-dimer in all the three groups at 72 h after surgery was higher than that before surgery. No DVT or other complication was observed in all patients. CONCLUSIONS Preoperative intravenous drip of TXA can remarkably reduce the intraoperative HBL and IBL in thoracolumbar fracture patients fixed with percutaneous pedicle screw. Nonetheless, intraoperative topical application of TXA before wound closure is not recommended.
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6.
The efficiency and safety of oral tranexamic acid in total hip arthroplasty: A meta-analysis
Xu Y, Sun S, Feng Q, Zhang G, Dong B, Wang X, Guo M
Medicine. 2019;98(46):e17796
Abstract
BACKGROUND Intravenous (IV), topical and combination of both application of tranexamic acid (TXA) can reduce blood loss, hemoglobin drop, and transfusion rate in patients following total hip arthroplasty (THA). Lately, published articles reported that oral TXA had as similar blood-saving as IV and topical TXA in THA. The purpose of this meta-analysis is to investigate the efficiency and safety of oral TXA in THA. METHODS We systematically searched articles about oral administration of TXA in THA from PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Chinese Wanfang database. STUDY ELIGIBILITY CRITERIA The outcomes were collected and analyzed by the Review Manager 5.3. RESULTS Nine RCTs and 1 CCT, containing 1305 patients, were ultimately included according to the inclusion criteria and exclusion criteria in the meta-analysis. The effectiveness of oral TXA was as similar as the IV or topical TXA in regard to hemoglobin drop (SMD = -0.14; 95% CI, [-0.28, 0.01]; P = .06), total blood loss (SMD = 0.01; 95% CI, [-0.13, 0.16]; P = .84), transfusion rate (OR = 0.76; 95% CI, [0.38, 1.55]; P = .37). Compared with single oral TXA or blank group, multiple oral TXA effectively reduced hemoglobin drop (SMD = -1.06; 95% CI, [-1.36, -0.77]; P < .05), total blood loss (SMD = -1.30; 95% CI, [-1.66, -0.94]; P < .05), transfusion rate (OR = 0.53; 95% CI, [0.29, 0.95]; P = .03). There were no significant difference in terms of length of stay and complication among all of enrolled studies. CONCLUSION Oral TXA has favorable effect of blood-saving and do not increase risk of complication in patients following THA. Oral TXA may have no effect in the length of stay. More high quality RCTs are necessary.
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7.
Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time: a network meta-analysis
Hao Z, Wang X, Zhang X
Journal of Orthopaedic Surgery and Research. 2018;13((1)):157.
Abstract
BACKGROUND Multiple operative treatments are available for the fixation of intertrochanteric femoral fractures. This analysis was conducted to provide guidance on the appropriate clinical choice to accommodate individual patients. METHODS A systematic review was performed to identify relevant articles in databases. Randomized controlled trials (RCTs) of adults with intertrochanteric femoral fractures were eligible if they compared 2 or more of the following interventions: proximal femoral nail anti-rotation (PFNA), percutaneous compression plate (PCCP) use, dynamic hip screw (DHS) fixation, gamma nail (GN) fixation, and artificial femoral head replacement (FHR). Bayesian network meta-analysis was performed to simultaneously compare all treatment methods. RESULTS In total, 24 active-comparator studies involving 3097 participants were identified. Across all populations, greater reductions in blood loss and operation time were observed for PFNA than for other treatments. In terms of bleeding, more blood loss was observed for DHS use than for the PFNA (SMD, 1.96; 95% CI, 1.01-1.96), PCCP (SMD, 1.26; 95% CI, 0.31-2.20), and GN (SMD, 0.26; 95% CI, - 0.35-0.87) techniques. However, a more beneficial effect was observed for DHS use than for FHR (SMD, - 0.23; 95% CI, - 1.26-0.81). DHS use resulted in a significantly longer duration of operation time than the PFNA (SMD, 0.75; 95% CI, - 0.02-0.75), PCCP (SMD, 0.61; 95% CI, - 0.20-1.44), and GN (SMD, 0.25; 95% CI, - 0.26-0.77) techniques. Similarly, greater reductions in operation time were observed for DHS use than for FHR (SMD, - 0.12; 95% CI, - 1.15-0.91). CONCLUSIONS The findings provide supporting evidence demonstrating the superiority of PFNA over other treatments for intertrochanteric femoral fracture. PFNA treatment results in the lowest amount of blood loss and the shortest operation time. These findings add to the existing knowledge of intertrochanteric femoral fracture treatment options.
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8.
Is combined topical and intravenous tranexamic acid superior to intravenous tranexamic acid alone for controlling blood loss after total hip arthroplasty?: a meta-analysis
Zhang H, He G, Zhang C, Xu B, Wang X, Zhang C
Medicine. 2017;96((21)):e6916.
Abstract
BACKGROUND We performed a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of combined intravenous (IV) and topical tranexamic acid (TXA) with IV-TXA alone for controlling blood loss in patients following primary total hip arthroplasty (THA). METHODS PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, the Google database, the Chinese Wanfang database, and the China National Knowledge Infrastructure database were searched to identify studies comparing combined IV and topical TXA with IV-TXA alone in patients who were prepared for THA. The weighed mean differences for total blood loss, hemoglobin drop, intraoperative blood loss, and the length of hospital stay were calculated. We calculated risk ratios for the need for transfusion and the occurrence of deep venous thrombosis (DVT) in the combined TXA and IV-TXA alone groups. Relevant data were analyzed using Reviewer Manager 5.3.0. RESULTS Eight RCTs with a total of 850 patients (combined TXA: n = 471; IV-TXA: n = 479) were included in this meta-analysis. Pooled results indicated that compared with the IV-TXA alone group, the combined TXA group was associated with a lesser need for transfusion, total blood loss, intraoperative blood loss, and hemoglobin drop (P < .05). There was no significant difference between the 2 groups for the length of hospital stay and the occurrence of DVT (P > .05). CONCLUSIONS The current meta-analysis indicated that combined topical and IV-TXA was a relatively effective hemostasis method compared with IV-TXA alone. The number of studies included in this meta-analysis is limited, and more studies are needed to verify the effects of combined IV and topical TXA in THA patients.
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9.
Effects of different methods of using pneumatic tourniquet in patients undergoing total knee arthroplasty: a randomized control trial
Zhang Y, Li D, Liu P, Wang X, Li M
Irish Journal of Medical Science. 2017;186((4):):953-959.
Abstract
BACKGROUND The goal of this work was to investigate the effects of different methods of using pneumatic tourniquet on reducing blood loss in patients undergoing cemented total knee arthroplasty (TKA). METHODS One hundred and fifty patients undergoing unilateral cemented TKA were randomly divided into three groups (50 patients per group). The tourniquet was used during the entire operation (Group A), used from the beginning of operation to the completion of joint replacement (Group B), and from the beginning of osteotomy to the completion of arthroplasty (Group C). The following parameters were recorded: intraoperative blood loss (IBL), postoperative blood loss (PBL), hidden blood loss (HBL), and total blood loss (TBL); operation time and tourniquet time; incidence of postoperative complications; and hospital for special surgery (HSS) score. RESULTS IBL, HBL, and TBL in group C was significantly less than that in group B (all P < 0.05). Tourniquet time in group C was significantly less than that in groups A and B (all P < 0.05). The incidence of tourniquet-related complications in group C (6%) was relatively lower than that in group A (10%) during hospitalization (P > 0.05). Post-operative HSS scores at 2 weeks after the operation in group C was significantly higher than that in group A and group B (all P < 0.05). CONCLUSIONS Our results suggest that using a tourniquet from the beginning of osteotomy to the completion of arthroplasty could significantly reduce TBL in TKA, and decrease the incidence of complications; thereby facilitating early post-operative functional recovery.