Tranexamic acid for the prevention and management of orthopedic surgical hemorrhage: current evidence

Figures & data

Table 1 Summary of included studies investigating the use of tranexamic acid in total hip arthroplasty and total knee arthroplasty

Study	Study design	DVT prophylaxis	Transfusion criteria	Intervention	Number of cases
					C	TA
Ekback et al^Citation28	THA, RCT	Dalteparin	All patients had preoperative autologous blood donation + intraoperative autotransfusion	10 mg/kg IV TA bolus (start of procedure +3 hours later) +1 mg/kg/h infusion for 10 hours after the first bolus	20	20
Johansson et al^Citation29	THA, RCT	Fragmin	Hb <90 g/L	Single bolus 15 mg/kg IV TA	53	47
Good et al^Citation30	TKA, RCT	Fragmin	Hb <90 g/L	10 mg/kg IV TA prior to toumiquet release +3 hours later	24	27
Alvarez et al^Citation32	TKA, RCT	Bemiparin	Hb <80 g/L or patients presented signs, symptoms, or both of hypoxia such as tachycardia, dyspnea, or syncope	10 mg/kg IV TA 30 minutes before toumiquet release and then 1 mg/kg/h infusion for 6 hours	49	46
Alshryda et al^Citation33	THA, RCT	Enoxaparin	Hb <70 g/L or Hb <80 g/L in symptomatic patients	1 g topical TA	81	80
Chang et al^Citation34	THA, retrospective	None	Hb <100 g/L	0.5 g topical TA	234	154
Wong et al^Citation18	TKA, RCT	Enoxaparin	Hb <80 g/L or Hb <100 g/L, if symptoms developed	1.5 or 3 g topical TA applied to joint for 5 minutes at end of surgery	35	31 33*
Alshryda et al^Citation35	TKA, RCT	Enoxaparin	Hb <70 g/L or Hb < 80 g/L in symptomatic patients	1 g topical TA	78	79
Gilbody et al^Citation36	THA, TKA, retrospective	Enoxaparin	Hb <80 g/L or Hb <100 g/L, if symptoms developed	3 g topical TA	88 61	86 69

Note:

* indicates the 31 patients who received 1.5g of TA and 33 patients who received 3.0g of TA.

Abbreviations: THA, total hip arthroplasty; TKA, total knee arthroplasty; RCT, randomized controlled trial; DVT, deep venous thrombosis; Hb, hemoglobin; IV, intravenous; TA, tranexamic acid; C, control.

EkbackGAxelssonKRyttbergLTranexamic acid reduces blood loss in total hip replacement surgeryAnesth Analg2000911124113011049894

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JohanssonTPetterssonLGLisanderBTranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patientsActa Orthop20057631431916156456

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GoodLPetersonELisanderBTranexamic acid decreases external blood loss but not hidden blood loss in total knee replacementBr J Anaesth20039059659912697586

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AlvarezJCSantiveriFXRamosIVelaEPuigLEscolanoFTranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is appliedTransfusion20084851952518067499

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AlshrydaSMasonJSardaPTopical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H)J Bone Joint Surg Am201395211969197424196467

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ChangC-HChangYChenDUengSNLeeMTopical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplastyClin Orthop Relat Res201447251552155724385043

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WongJAbrishamiAEl BeheiryHTopical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trialJ Bone Joint Surg (Am)2010922503251321048170

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AlshrydaSMasonJVaghelaMTopical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K)J Bone Joint Surg Am201395211961196824196466

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GilbodyJDhotarHSPerruccioAVDaveyJRTopical tranexamic acid reduces transfusion rates in total hip and knee arthroplastyJ Arthroplasty201429468168424095586

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