The use of antifibrinolytic drugs and many other agents have a critical importance in bleeding control. Tranexamic acid [4- (aminomethyl) cyclohexanecarboxylic acid] is a synthetic amino acid lysine derivative with antifibrinolytic activity in humans. There are many studies in the literature that show that it is effective and effective both systemically and locally in spinal surgery. However, all of these studies have investigated the effects of topical tranexamic acid on bleeding and its effect on fusion has not been investigated yet. Aim of this study is to investigate the effect of topical tranexamic acid on fusion using macroscopic, radiologic and microscopic techniques. After approve of ethics committee with the protocol number 19/2019 for 28 Wistar Albino rats underwent intertransvers fusion. All rats were randomized into four (4) groups, using sealed envelopes. Local tranexamic acid (Transamin® 100 mg/ml, Teva İlaç, İstanbul) doses was determined based on previously conducted studies; 1mg/kg (D1 group), 10mg/kg (D10 group), 100 mg/kg (D100 group) and no tranexamic acid (D0 group). At the end of 8. th. weeks all rats were evaluated with manuel palpation, mammography and histopathologic analysis. Radiographic examination was performed two times to evaluate the intra and inter observer differences. 2 rats in-group D0 died after the radiographic examination. Assessment of fusion with manual palpation revealed that use of local 1mg / kg tranexamic acid had no effect on fusion (p=0.32), however with increasing doses of tranexamic acid had negative effect on fusion (p=0.002). On radiologic examination, spearman's rho correlation coefficient was found to be moderate in the first evaluation (r=0.46) and high in second evaluation (r=0.61). Radiological examination revealed that the control group was the best in fusion (p=0.007), and that tranexamic acid affected fusion adversely, independent of dosage (p=0.27). Among the groups in histopathologic examination, no statistical difference was found (p=0.134). Local administration of tranexamic acid affects the intertransverse fusion adversely depending on the dosage macroscopically and it also affects fusion adversely independent of the dosage radiologically and histopathologically

Aims. Tranexamic acid (TXA) is now commonly used in major surgical operations including orthopaedics. The TRAC-24 randomized control trial (RCT) aimed to assess if an additional 24 hours of TXA postoperatively in primary total hip (THA) and total knee arthroplasty (TKA) reduced blood loss. Contrary to other orthopaedic studies to date, this trial included high-risk patients. This paper presents the results of a cost analysis undertaken alongside this RCT. Methods. TRAC-24 was a prospective RCT on patients undergoing TKA and THA. Three groups were included: Group 1 received 1 g intravenous (IV) TXA perioperatively and an additional 24-hour postoperative oral regime, Group 2 received only the perioperative dose, and Group 3 did not receive TXA. Cost analysis was performed out to day 90. Results. Group 1 was associated with the lowest mean total costs, followed by Group 2 and then Group 3. The differences between Groups 1 and 3 (-£797.77 (95% confidence interval -1,478.22 to -117.32) were statistically significant. Extended oral dosing reduced costs for patients undergoing THA but not TKA. The reduced costs in Groups 1 and 2 resulted from reduced length of stay, readmission rates, emergency department attendances, and blood transfusions. Conclusion. This study demonstrated significant cost savings when using TXA in primary THA or TKA. Extended oral dosing reduced costs further in THA but not TKA. Cite this article: Bone Jt Open 2022;3(7):536–542

Tranexamic acid (TXA) has been used to reduce blood loss during total hip arthroplasty (THA), but its use could increase the risk of venous thromboembolic disease (VTE). Several studies have reported that TXA does not increase the prevalence of deep vein thrombosis (DVT), but most of those used routine chemical thromboprophylaxis, thereby masking the potential increased risk of TXA on VTE. We wished to ascertain whether TXA increases the prevalence of VTE in patients undergoing THA without routine chemical thromboprophylaxis. We carried out a retrospective case-control study in 254 patients who underwent a primary THA, 127 of whom received TXA (1 g given pre-operatively) and a control group of 127 who did not. All patients had mechanical but no chemical thomboprophylaxis. Each patient was examined for DVT by bilateral ultrasonography pre-operatively and on post-operative days 1 and 7. TXA was found to statistically significantly increase the incidence of total DVT on post-operative day 7 compared with the control group (24 (18.9%) and 12 (9.4%), respectively; p < 0.05) but most cases of DVT were isolated distal DVT, with the exception of one patient with proximal DVT in each group. One patient in the control group developed a non-fatal symptomatic pulmonary embolism (PE). The use of TXA did not appear to affect the prevalence of either proximal DVT or PE. Cite this article: Bone Joint J 2015; 97-B:458–62

Aims. In total knee arthroplasty (TKA), blood loss continues internally after surgery is complete. Typically, the total loss over 48 postoperative hours can be around 1,300 ml, with most occurring within the first 24 hours. We hypothesize that the full potential of tranexamic acid (TXA) to decrease TKA blood loss has not yet been harnessed because it is rarely used beyond the intraoperative period, and is usually withheld from ‘high-risk’ patients with a history of thromboembolic, cardiovascular, or cerebrovascular disease, a patient group who would benefit greatly from a reduced blood loss. Methods. TRAC-24 was a prospective, phase IV, single-centre, open label, parallel group, randomized controlled trial on patients undergoing TKA, including those labelled as high-risk. The primary outcome was indirect calculated blood loss (IBL) at 48 hours. Group 1 received 1 g intravenous (IV) TXA at the time of surgery and an additional 24-hour postoperative oral regime of four 1 g doses, while Group 2 only received the intraoperative dose and Group 3 did not receive any TXA. Results. Between July 2016 and July 2018, 552 patients were randomized to either Group 1 (n = 241), Group 2 (n = 243), or Group 3 (n = 68), and 551 were included in the final analysis. The blood loss did differ significantly between the two intervention groups (733.5 ml (SD 384.0) for Group 1 and 859.2 ml (SD 363.6 ml) for Group 2; mean difference -125.8 ml (95% confidence interval -194.0 to -57.5; p < 0.001). No differences in mortality or thromboembolic events were observed in any group. Conclusion. These data support the hypothesis that in TKA, a TXA regime consisting of IV 1 g perioperatively and four oral 1 g doses over 24 hours postoperatively significantly reduces blood loss beyond that achieved with a single IV 1 g perioperative dose alone. TXA appears safe in patients with history of thromboembolic, cardiovascular, and cerebrovascular disease. Cite this article: Bone Joint J 2021;103-B(10):1595–1603

Tranexamic acid is a fibrinolytic inhibitor which reduces blood loss in total knee replacement. We examined the effect on blood loss of a standardised intravenous bolus dose of 1 g of tranexamic acid, given at the induction of anaesthesia in patients undergoing total hip replacement and tested the potential prothrombotic effect by undertaking routine venography. In all, 36 patients received 1 g of tranexamic acid, and 37 no tranexamic acid. Blood loss was measured directly per-operatively and indirectly post-operatively. Tranexamic acid reduced the early post-operative blood loss and total blood loss (p = 0.03 and p = 0.008, respectively) but not the intraoperative blood loss. The tranexamic acid group required fewer transfusions (p = 0.03) and had no increased incidence of deep-vein thrombosis. The reduction in early post-operative blood loss was more marked in women (p = 0.05), in whom this effect was dose-related (r = −0.793). Our study showed that the administration of a standardised pre-operative bolus of 1 g of tranexamic acid was cost-effective in reducing the blood loss and transfusion requirements after total hip replacement, especially in women

Background. Total joint replacement surgery is associated with large amounts of blood loss and significant rates of transfusions. Postoperative bleeding is one of the most important problems after major orthopedic surgeries including revision Total Hip Arthroplasty (THA). It has been demonstrate that Tranexamic acid is a useful agent to control the volume of blood loss. However, the more effective route of TXA administration remained controversial. Methods. In current study, we compared the effects of local and intravenous(IV) administration of TXA on need to blood transfusion and hemoglobin drop. We randomized 80 patients undergoing revision THA into two groups: local group and IV group. In group IV 40 patients was administrated TXA 4 g alone systemically and in local group 40 patients the joint was irrigated with 4 g of TXA plus 0.33mg DEP (1:200,000). Results. The level of Hb was measured before and after operation and the rate of Hb drop was compared. Also, the blood transfused were compared in two group. Results showed topical TXA plus DEP substantially reduced total blood loss, hidden blood loss and transfusion rate compared with TXA alone, without increasing the risks of hemodynamic complexity. Conclusion. We conclude that local use of TXA plus DEP was crucially effective and safe option compared with intravenous TXA alone in reducing total and hidden blood loss and transfusion rate following revision THA without considerable complications

Aims. This study investigated whether the use of tranexamic acid (TXA) decreased blood loss and transfusion related cost following surface replacement arthroplasty (SRA). . Methods. A retrospective review of patients treated with TXA during a SRA, who did not receive autologous blood (TXA group) was performed. Two comparison groups were established; the first group comprised of patients who donated their own blood pre-operatively (auto group) and the second of patients who did not donate blood pre-operatively (control). Outcomes included transfusions, post-operative haemoglobin (Hgb), complications, and length of post-operative stay. . Results. Between 2009 and 2013, 150 patients undergoing SRA were identified for inclusion: 51 in the auto, 49 in the control, and 50 in the TXA group. There were no differences in the pre-operative Hgb concentrations between groups. The mean post-operative Hgb was 11.3 g/dL (9.1 to 13.6) in the auto and TXA groups, and 10.6 g/dL (8.1 to 12.1)in the control group (p = 0.001). Accounting for cost of transfusions, administration of TXA, and length of stay, the cost per patient was $1731, $339, and $185 for the auto, control and TXA groups, respectively. . Discussion. TXA use demonstrated higher post-operative Hgb concentrations when compared with controls and decreased peri-operative costs. Take home message: Tranexamic acid safely limits allogeneic transfusion, maintains post-operative haemoglobin, and decreases direct and indirect transfusion related costs in surface replacement arthroplasty. Cite this article: Bone Joint J 2016;98-B:173–8

Background: Tranexamic acid has been shown to be effective in reducing blood loss and transfusion requirement in cardiac surgery and total knee replacement surgery. The most effective dose of tranexamic acid in hip arthroplasty surgery is not yet known. We investigated the effect of a pre-operative bolus 1g intravenous tranexamic acid on intra- and post-operative blood loss, transfusion requirement, and risk of venous thromboembolism following total hip arthroplasty. Results: We report a cohort comparison study of 73 patients who underwent primary hip arthroplasty. Thirty-six patients received tranexamic acid (TA group), and thirty-seven received no tranexamic acid (control group). Blood loss was measured directly intra-operatively, and indirectly post-operatively by haemoglobin and haematocrit measurement. Deep vein thrombosis (DVT) was investigated by venography. Patient demographics were similar between both groups. There was no significant difference in intra-operative blood loss between both groups. The early post-operative blood loss and total blood loss were significantly less in the tranexamic acid group. This effect of tranexamic acid was more significant in females who showed a dose-related relationship between tranexamic acid dose and blood loss. Fewer patients in the tranexamic acid group required blood transfusion. There was no increased incidence of DVT in the tranexamic acid group. The use of a single pre-operative 1g bolus of tranexamic acid administered before surgery is a safe, cost-effective method of reducing post-operative blood loss following total hip arthroplasty. The effect is more significant in females at this dose

Objectives. Tranexamic acid (TXA) is an anti-fibrinolytic medication commonly used to reduce perioperative bleeding. Increasingly, topical administration as an intra-articular injection or perioperative wash is being administered during surgery. Adult soft tissues have a poor regenerative capacity and therefore damage to these tissues can be harmful to the patient. This study investigated the effects of TXA on human periarticular tissues and primary cell cultures using clinically relevant concentrations. Methods. Tendon, synovium, and cartilage obtained from routine orthopaedic surgeries were used for ex vivo and in vitro studies using various concentrations of TXA. The in vitro effect of TXA on primary cultured tenocytes, fibroblast-like synoviocytes, and chondrocytes was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell viability assays, fluorescent microscopy, and multi-protein apoptotic arrays for cell death. Results. There was a significant (p < 0.01) increase in cell death within all tissue explants treated with 100 mg/ml TXA. MTT assays revealed a significant (p < 0.05) decrease in cell viability in all tissues following treatment with 50 mg/ml or 100 mg/ml of TXA within four hours. There was a significant (p < 0.05) increase in cell apoptosis after one hour of exposure to TXA (100 mg/ml) in all tissues. Conclusion. The current study demonstrates that TXA caused significant periarticular tissue toxicity ex vivo and in vitro at commonly used clinical concentrations. Cite this article: M. McLean, K. McCall, I. D. M. Smith, M. Blyth, S. M. Kitson, L. A. N. Crowe, W. J. Leach, B. P. Rooney, S. J. Spencer, M. Mullen, J. L. Campton, I. B. McInnes, M. Akbar, N. L. Millar. Tranexamic acid toxicity in human periarticular tissues. Bone Joint Res 2019;8:11–18. DOI: 10.1302/2046-3758.81.BJR-2018-0181.R1

We performed a randomised, controlled trial involving 150 patients with a pre-operative level of haemoglobin of 13.0 g/dl or less, to compare the effect of either topical fibrin spray or intravenous tranexamic acid on blood loss after total knee replacement. A total of 50 patients in the topical fibrin spray group had 10 ml of the reconstituted product applied intra-operatively to the operation site. The 50 patients in the tranexamic acid group received 500 mg of tranexamic acid intravenously five minutes before deflation of the tourniquet and a repeat dose three hours later, and a control group of 50 patients received no pharmacological intervention. There was a significant reduction in the total calculated blood loss for those in the topical fibrin spray group (p = 0.016) and tranexamic acid group (p = 0.041) compared with the control group, with mean losses of 1190 ml (708 to 2067), 1225 ml (580 to 2027), and 1415 ml (801 to 2319), respectively. The reduction in blood loss in the topical fibrin spray group was not significantly different from that achieved in the tranexamic acid group (p = 0.72)

Abstract. By next summer the number of patients in the tranexamic acid group will be much higher, probably around 50–60. Purpose. Tranexamic acid has been extensively studied in single total knee and total hip replacement patients. It has been found to reduce blood loss and transfusion rates, with no increase in the rate of venous thromboembolism. This study was undertaken to determine whether tranexamic acid reduces blood loss and the rate of blood transfusion after bilateral total knee replacement, which has a much higher transfusion rate. Method. The preoperative haemoglobin and the lowest postoperative haemoglobin for 30 consecutive bilateral tkr patients who received tranexamic acid was recorded. These were compared with a a consecutive series of 262 historic controls that did not receive tranexamic acid. All patients were operated on by the same surgeon. The surgical procedure was essentially unchanged throughout the study period. The decision to transfuse was made by the hospitalist, who did not know whether the patient received tranexamic acid. Data calculated included the percentage drop in haemoglobin, and the transfusion rate for each group. A subset of patients who were anaemic preoperatively (Hb < 125) were compared for each group. Results. For the control group, which did not receive tranexamic acid, the average preoperative haemoglobin was 138, and dropped to 85 postoperatively. This represented a 38% drop in haemoglobin. Of the 262 patients, 105 required transfusion, giving a transfusion rate of 40%. The average number of units transfused was 1.8. For the study group, which received tranexamic acid, the average preoperative haemoglobin was 133, and dropped to 97 postoperatively. This represented a 27% drop in haemoglobin. Of the 30 patients, only one required transfusion, giving a transfusion rate of 4%. That one patient required only one unit of blood. For the patients who were anaemic preoperatively (Hb < 125) the transfusion rate for the control group was 97%, and for the study group was 20% (1/5). Conclusion. Tranexamic acid markedly reduces blood loss and the rate of transfusion for patients undergoing bilateral total knee replacement

We have investigated the effect of using tranexamic acid (TXA) during peri-acetabular osteotomy (PAO) on peri-operative blood loss and blood transfusion requirements. In addition we analysed whether the use of TXA was associated with an increased risk of venous thromboembolism (VTE) following this procedure.

A consecutive series of 96 PAOs, performed by a single surgeon, were reviewed. A total of 48 patients received TXA and 48 did not. The TXA group received a continuous infusion of TXA at a rate of 10 mg/kg/h. The primary outcome measure was the requirement for blood transfusion. Secondary outcomes included total blood loss, the decrease in the level of haemoglobin in the blood, the length of hospital stay, and the complications of this treatment.

The mean rate of transfusion was significantly lower in the TXA group (62.5% vs 12.5%, p < 0.001). The mean blood loss was also significantly reduced in the TXA group (1.9 L (standard deviation (sd) 0.9) vs 1.5 L (sd 0.7), p < 0.01). No post-operative episodes of VTE were identified in either group.

The use of TXA reduced the blood loss and the rate of transfusion after PAO significantly, without adverse effects such as an increased rate of VTE.

Cite this article: Bone Joint J 2015;97-B:1604–7.

Aim We have prospectively investigated the effect of tranexamic acid in reducing blood loss and transfusion requirements in primary and revision total hip arthroplasty in a comparative study. Patients and Methods In the study group, tranexamic acid was given half an hour before the skin incision. (10 mg/kg as an intravenous bolus, followed by 10 mg/kg as intravenous infusion over 6 hours). We recorded the haemoglobin level preoperatively and prior to discharge, and number of units of blood transfused. The total peri-operative blood loss and the fall in haemoglobin after surgery was calculated in consultation with our haematologist. There were 9 primary and 17 revision hip replacements in the study group. We compared the results with a control group of 10 primary and 20 revisions performed during a similar period, without tranexamic acid, recording identical parameters. Thrombo-embolic and wound complications were recorded. Results Patients receiving tranexamic acid had a mean fall in haemoglobin level of 3.1 g/dl and mean blood loss of 4.1 litres. The control group operated without tranexamic acid had a mean fall in the level of haemoglobin of 3.7 g/dl, and the mean blood loss 5.4 litres. The average number of units of blood transfusion required was 0.77 per patient in the study group compared to 2.03 per patient in the control group. The differences were significant (p value of 0.05). There was no increase in the incidence of complications such as deep vein thrombosis, pulmonary embolism, or wound problems in the study group. Conclusion Tranexamic acid given prior to surgery reduces blood loss and need for blood transfusion, not only in primary but also in revision hip arthroplasty, without any increase in the rate of thrombo-embolic complications

Introduction: Numerous studies have been carried out to assess the efficacy of tranexamic acid on intra and post operative blood loss and its implications. Many of these studies conclude that there is a need to study the effects of tranexamic acid on actual post Operative blood transfusion, thromboembolic events and hospital stay. We analyzed the effects of Tranexamic acid on Intra- operative blood loss, post Operative haemoglobin and haematocrit drop, blood transfusion requirement, incidence of deep vein thrombosis and hospital stay in Patients undergoing Total hip arthroplasty. Methods: Prospective case control study involving 50 patients (25 in each category, ASA class I to III) operated by a single consultant. Patient were given single dose of Intra venous Tranexamic Acid (10 mg/kg,10 minutes pre-incision) and Intra operative blood loss was compared to control group analyzing dry and wet swab weights and irrigation fluid. The actual haemoglobin drop, blood transfusion requirement, average length of stay in hospital and incidence of DVT were noted. Results: There was 30% reduction in intra operative blood loss in the study group. None of the other parameters show evidence of a statistically significant difference between the groups. The average hospital stay was 7 days in both the groups. Discussion: We found out that Tranexamic acid makes little difference in terms of actual haemoglobin and haematocrit drop, blood transfusion requirement and hospital stay. Our study didn’t show any rise in deep vein thrombosis in treatment group. The only difference it made was reduction of intraoperative blood loss by 30%. To the best of our knowledge, ours is the only study which combines all these parameters

Purpose. Topical application of tranexamic acid (TXA) to bleeding wound surfaces reduces blood loss in patients undergoing some major surgeries, without systemic complications. The objective of this study was to determine if TXA applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary bipolar hemiarthroplasty (BA). Methods. We retrospectively compared 77 patients undergoing hip arthroplasty surgery in which tranexamic acid was routinely used, to a group of 70 patients from a similar time frame prior to the introduction of tranexamic acid use. In the former group 40 patients had THA and 37 patients BA; in the latter group 35 patients underwent THA and 35 patients BA. In both THA and BA, the joint was bathed in TXA solution (at a concentration of 3.0 g TXA per 100 mL saline) at three points during the procedure. The primary outcome was blood loss calculated from the difference between the preoperative hemoglobin level and the corresponding lowest postoperative value or hemoglobin level prior to transfusion. Results. Postoperative transfusions decreased significantly with TXA, dropping from 50.0% to 27.5%, and from 63% to 48%, in the THA and BA groups, respectively. We also found significant reductions in hemoglobin loss and blood loss of 8 g/dL and 336 mL respectively for THAs and 6 g/dL and 176 mL respectively for BAs following the introduction of tranexamic acid. There was no difference in the rates of deep-vein thrombosis or pulmonary embolism between the two groups. Discussion and Conclusion. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in THA and BA, with no clinically important increase in complications being identified

Background:. Role of intra-articular Tranexamic acid in total knee replacement arthroplasty. Materials and methods. Prospective evaluation was done to see the effect of intra-articular Tranexamic acid on blood loss in 60 patients (120 knees) undergoing total knee arthroplasty. All the patients were operated by one surgeon with same technique by using same implants. Patients were randomly injected 1500 mg/20 ml of Tranexamic acid on one side of the knee only. Nothing was injected on the contra lateral knee. Evaluation was done for swelling and the amount of blood loss in the drain. Results:. Average blood loss in the drain on Tranexamic side was 140 ml and the opposite side was 390 ml. Swelling was more observed on the non Tranexamic side. Average time for drain removal on Tranexamic side was 36 hours while it was 48 hours on non Tranexamic side. Early mobilization and weight bearing was less painful in Tranexamic side. No patient had systemic complications of Tranexamic acid. Conclusion:. Intra-articular injection of Tranexamic acid reduces blood loss, swelling around the knee without systemic side effects and allows early weight bearing and mobilization of the joint

Background: Total hip replacement (THR) is one of the commonest operations in orthopaedic practice. Literature review showed that 20–70% of patients who underwent THR needed 1–3 units of blood. Although safer than ever, allogeneic transfusion is still associated with risks for the recipient. There has been unsettled search for ways to reduce such blood loss and transfusion. Tranexamic acid has been popularised as an effective way to reduce blood loss and subsequent blood transfusion. Objectives: To investigate the value of Tranexamic acid in reducing blood loss and blood transfusion after THR and other clinical outcomes such as deep venous thrombosis (DVT), pulmonary embolism (PE), ischaemic heart diseases and mortality. Patients and Methods: A systematic review and meta-analysis of published randomised and quasi-randomised trials which used tranexamic acid to reduce blood loss in hip arthroplasty was conducted. The data was evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. Results:. Blood loss. Seven studies (250 patients) were eligible for this outcome. Using Tranexamic acid reduced blood loss by an average of 155 ml (P-value < 0.00001, 95% CI (87–224), Heterogeneity I2 69 %.). Blood transfusion. Nine studies (463 patients) were eligible for this outcome. Tranexamic acid led to a reduction in the proportion of patients requiring blood transfusion (Odds Ratio of 0.35, P- value < 0.00001, 95% CI (0.22–0.55), Heterogeneity I2 25 %.). Other outcomes. There were no significant differences in the length of stay, DVT, PE, mortality, wound haematoma or infections between the study groups. Conclusion: The use of Tranexamic acid in THR results in significant reduction of blood loss and blood transfusion

Aims. Tranexamic acid (TXA) has been shown to significantly reduce transfusion rates in primary total hip arthroplasties (THAs), but high-quality evidence is limited in the revision setting. The purpose of the current study was to compare the rate of blood transfusions and symptomatic venous thromboembolic events (VTEs) in a large cohort of revision THAs treated with or without intravenous (IV) TXA. Patients and Methods. We performed a retrospective review of 3264 revision THAs (2645 patients) between 2005 and 2014, of which 1142 procedures received IV TXA (1 g at incision and 1 g at closure). The mean age in the revision group with TXA was 65 years (28 to 95), with 579 female patients (51%). The mean age in the revision group treated without TXA was 67 years (21 to 98), with 1160 female patients (55%). Outcomes analyzed included rates of transfusion and symptomatic VTEs between procedures undertaken with and without TXA. These comparisons were performed for the overall cohort, as well as within cases subcategorized for aseptic or septic aetiologies. A propensity score was developed to minimize bias between groups and utilized age at revision THA, sex, body mass index, American Society of Anesthesiologists (ASA) score, preoperative anticoagulation, and year of surgery. Results. Tranexamic acid significantly and substantially reduced the rate of blood transfusions after revision THA overall from 54% to 26% (p < 0.001; adjusted relative risk (RR) 1.6; 95% confidence interval (CI) 1.3 to 1.9), with a significant reduction in both aseptic (49% to 18%; p < 0.001) and septic (73% to 53%; p = 0.04) revisions. The rate of VTE was minimal overall, with three events (0.3%) in the TXA group and four events (0.2%) in the non-TXA group. There were no significant differences in VTE rates based on TXA use or aetiology of revision. Conclusion. Intravenous TXA significantly reduced transfusion rates during all-cause revision THAs, including a subgroup analysis of both aseptic and septic cohorts. Adjusted risk using propensity modelling showed no statistical difference in rates of VTEs between either group. Cite this article: Bone Joint J 2019;100-B(6 Supple B):104–109

Objectives. Tranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA. Materials and Methods. A systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software. Results. A total of ten RCTs (1143 patients) were included in this study. All the included studies were randomised and the quality of included studies still needed improvement. The results indicated that, compared with either placebo or the single-dose TXA (IV or IA) group, the combination of IV and IA TXA group had significantly less total blood loss, hidden blood loss, total drain output, a lower transfusion rate and a lower drop in haemoglobin level. There were no statistically significant differences in complications such as wound infection and deep vein thrombosis between the combination group and the placebo or single-dose TXA group. Conclusions. Compared with placebo or the single-dose TXA, the combined use of IV and IA TXA provided significantly better results with respect to all outcomes related to post-operative blood loss without increasing the risk of thromboembolic complications in TKA. Cite this article: Z. F. Yuan, H. Yin, W. P. Ma, D. L. Xing. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: combined tranexamic acid for TKA. Bone Joint Res 2016;5:353–361. DOI: 10.1302/2046-3758.58.BJR-2016-0001.R2

Introduction: Knee replacement surgery is associated with minimal intraoperative blood loss, but marked postoperativelloss. Allogenic blood transfusions are associated with known risks. The need to establish programmes of blood conservation in knee replacement surgery becomes evident. We present a retrospective comparative study of 3 blood salvage methods used in TKR: autologous blood donation, cell saver and tranexamico acid. The purpose of this study is to asses the results of tranexamic acid compared with other used methods. Material and methods: We reviewed 90 TKR operated during 2002–2003 with the same technique and by the same surgical team. 3 patients cohorts have been done based on the blood saving method used,. Patients and surgical variables were recorded, to confirm the homogeneity of the groups. Haemoglobin and hematocrit levels in preoperative, early postoperative and late postoperative were collected, as well as blood loss and the number of blood units transfused. Results: The statistic analysis of the 3 groups didn’t show any differences between them, assuring the homogeneity. ANOVA statistical analysis was done, showing significative differences in the early postoperative Hb and HTC, 9.4 g/dL −28.1% in autologous group, 9.6g/dL−28.5% in cell saver group and 10.8g/dl−31.4% in the tranexamic acid group. Total blood loss was 1088.5 mL in the autologous group, 1080mL in the cell saver group and 690.3 mL in the tranexamic acid group, showing significant differences (p.< 0.001). The autologous group received 1.4 units of blood per patient, compared with 0.6 in the cell saver group and 0.2 in the tranexamic acid group (p< 0.05). Conclusions: We conclude that the use of tranexamic acid in total knee replacement reduces postoperative blood loss, keeps Hb and HTC during the postoperative and significatively reduces the need of blood transfusion compared with other systems