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Abstract Background Tranexamic acid (TXA) is a widely employed intervention in orthopedic surgeries to minimize blood loss and the need for postoperative transfusions. This study focuses on assessing the efficacy and safety of TXA specifically in undernourished older adults undergoing hip fracture procedures. Methods A total of 216 patients were classified into two groups based on the Geriatric Nutritional Risk Index: undernourished and normal. In total, 82 patients received intravenous TXA at a dosage of 15 mg/kg before incision, with an additional 1 g administered intravenously over a 3-hour period postoperatively. Postoperative hemoglobin (Hb) drop, blood transfusion rate, and the incidence of deep venous thrombosis (DVT) were assessed in each group according to the presence or absence of TXA. Additionally, demographic factors including age, sex, body mass index, and serum albumin were investigated. Results 51.9% patients were identified as undernourished, experiencing progressive anemia (Hb: 10.9 ± 1.5 g/dL) and hypoalbuminemia (serum albumin: 31.9 ± 8 g/L). In comparison with the normal group, undernourished individuals were more likely to sustain femoral neck fractures (undernutrition vs. normal: 56.2 vs. 42.3%) and less likely to incur trochanteric fractures (undernutrition vs. normal: 43.8 vs. 57.7%) (P = 0.043). TXA administration significantly reduced the transfusion rate (P = 0.014) and Hb drop (P = 0.001) in the normal nutritional group, while its impact on the undernourished group remained less pronounced. There was no significant association between TXA administration and the rate of DVT complications, irrespective of the nutritional status. Conclusions Undernutrition not only diminishes muscle strength and gait function, leading to various types of hip fractures, but it may also hinder the efficacy of TXA in reducing blood transfusion rates and blood loss.

Video-assisted thoracoscopic surgery (VATS) has demonstrated its efficacy and improved clinical outcomes as an option for early-stage non-small cell lung cancer. The development of robotic-assisted thoracoscopic surgery (RATS) has become the newest alternative to VATS. This study aims to compare VATS and RATS in terms of clinical outcomes. This Systematic Review research used the PRISMA method. RATS is proven to be an alternative with superior results compared to VATS on the Mortality in 30 days parameter (OR 0.59, 95% CI = 0.40, 0.86, I2 : 0%; p<0.006) and transfusion rate (OR = 0.50; 95% CI: 0.27 - 0.92, I2: 6%; p = 0.34). There was no significant difference between the RATS vs VATS procedure in terms of duration of surgery (OR = 0.50; 95%CI: 0.27 - 0.92), and intraoperative complications (OR 1.98, 95%CI: 0.12 - 32.44) and postoperative complications (OR 1.05, 95%CI: 0.93 - 1.19). The parameters of length of stay and chest drain duration in most of the studies show that VATS requires longer treatment time and thoracic drainage time than RATS. RATS can be an alternative to minimally invasive surgery in early-stage lung cancer with a lower risk of death and transfusion requirements than VATS, but there is no difference in the duration of surgery, as well as intraoperative and postoperative complications. [ABSTRACT FROM AUTHOR]

Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data.

Background: Blood transfusion is an important part of patient management in obstetrics and gynaecology. There is a need to periodically assess blood transfusion practices in order to identify areas for improvement. Objectives: This study aimed to determine the rate of blood transfusion, indications, local use pattern, and variability of blood type transfused. Patients, Materials and Methods: A prospective observational study over six months was conducted at the Rivers State University Teaching Hospital. Obstetric patients in the peripartum period and gynaecological admissions who underwent blood transfusion were included. The patients' characteristics, blood type, pretransfusion packed cell volume (PCV), indication for transfusion, blood product used, number of pints, and donor group were recorded. Analysis was performed using SPSS version 23, and statistical significance was set at P < 0.05. Results: Overall, 84 out of 1000 patients were transfused, giving a rate of 8.4%, 7.4% in obstetric patients, and 13% in gynaecological patients. Haemorrhage was the main reason for transfusions in obstetrics 40 (65.6%), made up of postpartum haemorrhage 27 (44.3%) and antepartum haemorrhage 13 (21.3%), while antepartum anaemia was 17 (27.9%). In gynaecology, chronic anaemia was the main reason for transfusions 10 (43.5%), while acute haemorrhage was 7 (30.4%). Blood components used were whole blood 66.7% (56/84) and sedimented blood 33.3% (28/84) only. About a quarter of the patients who received blood transfusion, had a pretransfusion PCV of 25% or more (20/84) and received only one pint of blood (21/84). Conclusion: The rate of blood transfusion was relatively high, with gynaecology rates higher than obstetric. The indication for blood transfusion in obstetrics was mainly haemorrhage, while in gynaecology, it was chronic anaemia.

Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data. [ABSTRACT FROM AUTHOR]

The coronavirus disease (COVID-19) outbreak affected the utilization and management of blood products in hospitals. Blood shortages occurred owing to social distancing policies and reduction in blood donors. However, only a few studies examined whether these changes affected blood usage and transfusion patterns. We retrospectively reviewed blood component usage according to hospital departments and phases of surgery in transfused patients admitted between 1 March 2019 and 28 February 2021, in a single center in Anyang, Korea. We also analyzed the length of hospital stay and mortality to determine prognosis. In 2020, 32,050 blood components were transfused to 2877 patients, corresponding to 15.8% and 11.8% less than the rates in 2019, respectively. Postoperative usage of blood products significantly decreased in 2020 (3.87 ± 6.50) compared to 2019 (7.12 ± 21.71) (p = 0.047). The length of hospital stay of the patients who underwent postoperative transfusion in 2019 (n = 197) was 13.97 ± 11.95 days, which was not significantly different from that in 2020 (n = 167), i.e., 16.44 ± 17.90 days (p = 0.118). Further, 9 of 197 postoperative transfusion patients died in 2019, while 8 of 167 patients died in 2020 (p = 0.920). The COVID-19 pandemic resulted in limited blood supply and reduced postoperative transfusions; however, patient prognosis was not affected. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study was to investigate the use of tranexamic acid in patients with proximal femoral fractures and compare the total blood loss, transfusion rates, complications, and the application method. Methods: A retrospective single center cohort study (level I trauma center) with 1479 patients treated operatively for a proximal femoral fracture between January 2016 and June 2020 was performed. 1 g of tranexamic acid was applied (systemic, topic or combined application). Patient data, surgical procedure, complications, and mortality were assessed. Hemoglobin levels, blood loss and transfusion rates for patients with and without tranexamic acid and the application methods were compared. Results: 667 femoral neck fractures, 701 pertrochanteric and 109 subtrochanteric fractures were included. Mean age was 80.8 years. 274 patients received tranexamic acid. At admission average hemoglobin was 12.2 g/l. Hemoglobin drop postoperatively was less after tranexamic acid (9.72 vs. 9.35 g/dl). Transfusion rates were lowered significantly by 17.1% after tranexamic acid. Blood loss was reduced for all patients after tranexamic acid independent of fracture morphology. The combination of 1 g i.v. and 1 g topical-applied tranexamic acid seems to be more effective. Complication rates did not differ. Conclusion: Tranexamic acid is effective in reducing blood loss and transfusion rates, without increasing the risk of thromboembolic events after proximal femoral fractures. For open reduction and nailing and arthroplasty in fracture setting combined topical and single i.v. application seems most effective and closed reduction with nailing can be treated by single dose i.v. application of 1 g tranexamic acid. [ABSTRACT FROM AUTHOR]

Purpose: Although numerous systematic reviews and meta-analyses have established the efficacy of tranexamic acid (TXA) in hip fracture surgeries, the included studies in those reviews have included all types of surgical interventions ranging from fixation to arthroplasty. Hip hemiarthroplasty is usually indicated in the elderly patients with femoral neck fracture and these patients have associated severe comorbidities and cognitive impairment. These subsets of patients with femoral neck fracture needs appropriate perioperative care and judicious use of antifibrinolytics. There is no meta-analysis evaluating the safety and efficacy of intravenous TXA in these patients. Methods: Searches of PubMed, Embase and Cochrane Central Register of Controlled Trials databases revealed 102 studies on TXA in hip fracture surgeries. After screening, eight studies were found to be suitable for review. The primary objective of this meta-analysis was to compare blood transfusion rate between TXA vs. control in hip hemiarthroplasty. The secondary objectives were total blood loss, postoperative haemoglobin, surgical duration, length of hospital stay and side effects (VTE, readmission and 30 days mortality). Results: There were one RCT, one prospective cohort study and six retrospective studies. All studies recruited the elderly patients. Intravenous (IV) TXA administration resulted in significant reduction in requirement of blood transfusion (12.7% vs. 31.9%; OR 0.28; 95% CI 0.17–0.46; p < 00,001; I2 = 73%). The TXA group had significantly decreased total blood loss (MD − 100.31; 95% CI − 153.79, − 46.83; p < 0.0002). The postoperative Hb in the TXA group was significantly higher than the control group (MD 0.53; 95% CI 0.35, 0.71; p < 0.00001). There was no significant difference in the incidences of VTE (0.97% vs. 0.73%, OR 1.27; p = 0.81; I2 = 64%) and readmission rate (9.2% vs. 9.64%; OR 0.79; p = 0.54), but 30-d mortality rate was significantly lower in the TXA group (3.41% vs. 6.04%; OR 0.66; p = 0.03). Conclusions: Intravenous TXA is efficacious in the reduction of blood loss and transfusion need in hip hemiarthroplasty surgery for hip fracture, without increased risk of VTE. The blood conservation protocol led to decreased 30 days mortality in these fragile elderly patients. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Introduction: Hip resurfacing (HR) requires a larger approach and soft tissue dissection and might therefore be associated with increased blood loss compared to total hip arthroplasty (THA). However, the effect of the adoption of tranexamic acid (TXA) in this setting is unknown. Therefore, the current study compares the blood loss and transfusion requirements between HR and posterior THA in patients receiving TXA.Materials and Methods: This retrospective cohort study included patients undergoing primary, unilateral THA or HR using a posterior approach between February 2016 and 2020 in which TXA was administered. THA and HR patients were propensity score matched using nearest neighbor greedy matching accounting for demographic, health and surgical variables. Postoperative hemoglobin (Hgb) levels and Hgb drop from preoperative to post-operative day (POD) 1 were compared using t-tests and associated risk factors were assessed using linear mixed modelling.Results: After matching, each cohort consisted of 1395 patients. Cohorts were similar regarding age, sex, BMI, and Charlson Comorbidity Index. No significant differences were found for Hgb levels on POD 1 (12.3 g/dl; p = 0.90) or Hgb drop (2.3 g/dl; p = 0.87). Duration of surgery was significantly longer for HR patients (82 vs 77 min; p < 0.01). Transfusion rate was 0.1% in both cohorts (p = 1.00). Hospital stay was significantly shorter for HR patients (1 vs 2 days; p < 0.01).Conclusion: HR using a standard TXA regimen is not associated with greater perioperative blood loss than posterior THA and does not result in increased transfusion requirements. Both surgical procedures can be considered equally safe in terms of perioperative blood management when TXA is used. [ABSTRACT FROM AUTHOR]

Aryan Haratian, Tara Shelby, Laith K Hasan, Ioanna K Bolia, Alexander E Weber, Frank A Petrigliano USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USACorrespondence: Frank A PetriglianoUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USATel +1 323 442-5822Email Frank.Petrigliano@med.usc.eduAbstract: Tranexamic acid (TXA) is a lysine analog that exhibits an anti-fibrinolytic effect by directly preventing the activation of plasminogen as well as inhibiting activated plasmin from degrading fibrin clots, thereby promoting hemostasis and reducing the duration and quantity of blood loss. The aims of this study were to summarize the indications, routes of administration, safety, and clinical outcomes of TXA use throughout the different subspecialities in orthopedic surgery. Given that orthopedic procedures such as TKA, THA, fracture fixation, and various spine surgeries involve significant intraoperative blood loss, TXA is indicated in providing effective perioperative hemostasis. Additionally, use of TXA in orthopedic trauma has been indicated as a measure to reduce blood loss especially in a group with potential for hemodynamic compromise. TXA has been implicated in reducing the risk of blood transfusions in orthopedic trauma, joint surgery, and spine surgery, although this effect is not seen as prominently in sports medicine procedures. There remains disagreement in literature as to whether TXA via any route of administration can improve other clinically significant outcomes such as hospital length of stay and total operative time. Procedures that rely extensively on clarity on visualization of the surgical field such as knee and shoulder arthroscopies can greatly benefit from the use of TXA, thereby leading to less intraoperative bleeding, with better visual clarity of the surgical field. While most studies agree thrombosis due to TXA is unlikely, new research in cells and animal models are evaluating whether TXA can negatively impact other aspects of musculoskeletal physiology, however with conflicting results thus far. As of now, TXA remains a safe and effective means of promoting hemostasis and reducing intraoperative blood loss in orthopedic surgery.Keywords: tranexamic acid, TXA, orthopaedic surgery, operative blood loss, transfusion rate, outcomes

The coronavirus disease (COVID-19) outbreak affected the utilization and management of blood products in hospitals. Blood shortages occurred owing to social distancing policies and reduction in blood donors. However, only a few studies examined whether these changes affected blood usage and transfusion patterns. We retrospectively reviewed blood component usage according to hospital departments and phases of surgery in transfused patients admitted between 1 March 2019 and 28 February 2021, in a single center in Anyang, Korea. We also analyzed the length of hospital stay and mortality to determine prognosis. In 2020, 32,050 blood components were transfused to 2877 patients, corresponding to 15.8% and 11.8% less than the rates in 2019, respectively. Postoperative usage of blood products significantly decreased in 2020 (3.87 ± 6.50) compared to 2019 (7.12 ± 21.71) (p = 0.047). The length of hospital stay of the patients who underwent postoperative transfusion in 2019 (n = 197) was 13.97 ± 11.95 days, which was not significantly different from that in 2020 (n = 167), i.e., 16.44 ± 17.90 days (p = 0.118). Further, 9 of 197 postoperative transfusion patients died in 2019, while 8 of 167 patients died in 2020 (p = 0.920). The COVID-19 pandemic resulted in limited blood supply and reduced postoperative transfusions; however, patient prognosis was not affected.

Background: To evaluate the transfusion rates for octogenarians and nonagenarians following total knee and hip arthroplasty (TKA, THA), we compared transfusion rates and associated risk factors among sexagenarians, septuagenarians, octogenarians, and nonagenarians.Methods: This retrospective cohort study included 13,603 sexagenarians, 9796 septuagenarians, 2706 octogenarians, and 158 nonagenarians that received a primary, unilateral THA or TKA between 2016 and 2020 at a high-volume institution. Using multivariable logistic regression analysis, the study analyzed risk factors for postoperative transfusions including use of tranexamic acid (TXA) and compared preoperative and postoperative hemoglobin (Hgb) levels and the drop in Hgb.Results: Nonagenarians had significantly higher transfusion rates (THA 25.5%, TKA 26.7%) than octogenarians (THA 9.9%, TKA 9.2%), septuagenarians (THA 3.3%, TKA 4.5%), and sexagenarians (THA 1.9%, TKA 2.9%) (P < .01). Significant risk factors for transfusion requirement following THA were American Society of Anesthesiologists level III (odds ratio [OR] 5.3, P < .01) and American Society of Anesthesiologists level IV (OR 8.0, P = .01), nonuse of TXA (intravenous: OR 0.3, P < .01; topical: OR 0.5, P < .01), lower preoperative Hgb levels (OR 0.4, P < .01), longer duration of surgery (OR 1.0, P < .01), and hepatopathy (OR 3.1, P < .01). Significant risk factors following TKA were nonuse of TXA (intravenous: OR 0.3, P < .01; topical: OR 0.5, P < .01; combined: OR 0.2, P < .01), lower preoperative Hgb levels (OR 0.4, P < .01), and longer surgery time (OR 1.0, P < .01).Conclusion: The strongest independent risk factors for increased transfusion rates among octogenarians and nonagenarians were lack of TXA application and lower preoperative Hgb levels. Routine TXA application and preoperative patient optimization are recommended to reduce transfusion rates in patients aged 80+. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the difference between the drainage volume, blood loss, transfusion rate, volume, and complications with or without an intra-articular (IA) tranexamic acid (TXA) injection among patients who underwent simultaneous bilateral total knee arthroplasty (SBTKA) with bilateral knee joint osteoarthritis, including patients who have contraindications of intravenous administration. Materials and Methods: Among patients who underwent SBTKA from April 2016 to December 2018, 139 patients injected with 3 g of TXA in each side through a drainage tube after joint capsule repair (group T), and 57 patients (group A) who underwent the procedure without TXA between October 2007 and August 2010 were tested. No significant difference in age and sex was observed between the two groups (p=0.572, 0.474). TXA was injected in patients with contraindications of intravenous administrations. Patients who underwent SBTKA with inflammatory arthritis were excluded from this study. The average amount of drainage, blood loss, transfusion rate, volume and daily average transfusion rate, and hemoglobin (Hb) change by the postoperative day were compared. Complications, such as deep vein thrombosis, pulmonary thromboembolism, myocardial infarction, cerebral infarction, and infection, were investigated. Results: The average total blood losses in groups A and T were 2195.32±1175.63 ml and 1145.09±382.95 ml, respectively, and the average total drain volume was 1,178.30±48.59 ml and 774.19±310.06 ml, respectively; both were significantly lower in group T (p=0.002, <0.001). The transfusion rates were 77.2% (44/57) and 0.7% (1/139), which were significantly lower in group T (p<0.001). The total average transfusion volume in groups A and T were 735.44±550.83 ml and 4.60±54.28 ml, respectively, which were significantly lower in group T (p<0.001). Hb tended to increase for three or four days after surgery in group A and group T. Regarding complications, deep vein thrombosis was encountered in two cases (1.4%), and pulmonary thromboembolism was noted in three cases (2.2%) in group T, but there were no cases in group A. No infections, cerebral infarction, or myocardial infarction occurred. Conclusion: In SBTKA, IA injections of TXA reduced the average drain volume, blood loss, transfusion rate, and volume significantly and did not increase the incidence of complications, even in patients with contraindications of intravenous administration. [ABSTRACT FROM AUTHOR]

Senohadi Boentoro, Irfan Wahyudi, Chaidir A Mochtar, Agus Rizal AH Hamid Department of Urology, Faculty of Medicine, Indonesia University, Jakarta, IndonesiaCorrespondence: Irfan Wahyudi Email irf.wahyudi2011@gmail.comIntroduction: Laparoscopic surgery has been acknowledged to reduce the morbidity rate thus improving patient safety. During the LLDN, the most frequent complication is renal vessels injuries, which often requires a blood transfusion. Besides the need for a blood transfusion, major bleeding caused by renal vessels injuries requires open conversion and repair. Thus, this study would like to descript and analyze the need for blood transfusion in laparoscopic living donor nephrectomy surgery in our center.Methods: We performed a retrospective cohort study in the Department of Urology at Cipto Mangunkusumo National Hospital. The records of all kidney transplantation donor patients who underwent LLDN procedures carried out at our institution from November 2011 to October 2017 were reviewed. Data including donor age, preoperative hemoglobin level, postoperative hemoglobin level, intraoperative bleeding, number of artery(ies), number of vein(s), donor side, conversion to open surgery, surgery duration, and donor BMI were collected and analyzed. These data were further correlated with the transfusion rate.Results: There were 500 patients underwent laparoscopic living donor nephrectomy procedure at our institution. All of the patients had LLDN with a transperitoneal approach. The difference in blood transfusion rate proportion between male patients with 0.9% compared to 0.6% in female patients was not significant (p=0.782). There is no significant difference in blood transfusion rate proportion regarding renal side (p=0.494), number of artery (p=0.362), age (p=0.978), BMI (p=0.569), and preoperative hemoglobin (p=0.766). Median estimated blood loss in patients who received intraoperative blood transfusion was significantly much greater than in patients who did not receive a blood transfusion (p< 0.001).Conclusion: Based on this study, we suggest that in our institution, preoperative blood products are not necessarily needed. The surgeon’s learning curve and technique play a significant role in preventing intraoperative complications and blood loss.Keywords: transfusion rate, laparoscopic living donor nephrectomy, renal transplantation

Background: Intravenous tranexamic acid (TXA) administration is a proven safe and effective method for reducing both blood loss and transfusion in total joint arthroplasty. However, data specific to its efficacy in hip hemiarthroplasty (HHA) for femoral neck fracture are scarce. Furthermore, no study has investigated the efficacy of an additional dose of TXA administration. Accordingly, this study aimed to assess blood loss and the transfusion rate compared among different regimens of TXA administration in patients undergoing HHA for femoral neck fracture.Methods: Between January 2019 to December 2020, 90 HHA patients were randomized into one of three groups (30 patients/group). Control group patients received intravenous normal saline solution (NSS) 20 mL before skin incision, and NSS 20 mL at 3 hours after surgery. one-dose (1D) group patients received 750 mg of intravenous TXA before skin incision, and NSS 20 mL at 3 hours after surgery. Two-dose (2D) group patients received 750 mg of intravenous TXA before skin incision, and 750 mg of TXA at 3 hours after surgery. The primary outcome was blood transfusion rate. Intraoperative blood loss, hemoglobin levels at 24- and 48-hours postoperation, and calculated total blood loss were compared among the three groups.Results: The mean age of the study population was 79.7 years, and 76.7% of participants were women. The transfusion rate in the control, 1D and 2D groups was 43.3%, 16.7%, and 3.3%, respectively. Total hemoglobin loss; total red blood cell loss; intraoperative blood loss; hemoglobin level at 24- and 48-hours postoperation; change in hemoglobin level between 0 and 24 hours, and between 0 and 48 hours; blood transfusion rate; and, the number of patients who did not require blood transfusion were all significantly improved in the 2D group compared to baseline. No parameters were significantly improved in the 1D group compared to controls.Conclusions: The results of this study demonstrate both the efficacy of TXA administration in HHA, and the superiority of two-dose TXA administration over one-dose TXA administration in HHA for femoral neck fracture. [ABSTRACT FROM AUTHOR]

Abstract Background Tranexamic acid (TXA) is effective in reduction of hemorrhage after major surgical procedures. In total joint replacement it is commonly administered intravenously. Despite various studies regarding the safety of its antifibrinolytic effect there are contraindications for systemic use. In total knee arthroplasty (TKA) TXA can also be administered intraarticular. However, there is a lack of studies focusing on dosage, effectiveness and complications of this local treatment. This study aimed to evaluate if blood loss and transfusion rate can be reduced in primary TKA by local application of TXA. Methods We included a total of 202 consecutive primary, unilateral TKA patients, 101 without and 101 with intraartricular application of 2 g TXA. Surgery was conducted after a standardized protocol. Blood loss, transfusion and complication rates were evaluated until three months after surgery. Blood loss was estimated using the hematocrit-value (Hk) prior and five days after surgery by Rosenecher’s and Mercuriali’s formula. Results By the use of TXA a significant reduction of blood loss (Rosencher average 1220 ml vs 1900 ml, Mercuriali average 430 ml vs 700 ml p

Objectives: Total shoulder arthroplasty (TSA) represents a major orthopedic procedure with significant blood loss and transfusion rates up to 43%. Tranexamic acid (TXA), a synthetic amino acid derivative, functioning by inhibiting the conversion of plasminogen to plasmin, has been proven to reduce blood loss in total knee or hip arthroplasty. However, very few studies exist regarding shoulder arthroplasty. The aim of the present review is to evaluate its effectiveness in shoulder arthroplasty. Materials and methods: A meticulous electronic search was performed to find articles reporting the results of TXA administration in TSA or reverse total shoulder arthroplasty (RTSA). Patients’ demographics, dose and timing of TXA administration, the type of control group, mean hemoglobin reduction, transfusion rate and total blood loss were evaluated. A total of eight studies including 981 patients were identified. Five hundred and thirty patients (group 1) received TXA, while the remaining 451 comprised the control group (group 2). Results: The mean postoperative reduction in hemoglobin in group 1 was found to be 2.14 g/dL (SD=0.62), compared to 2.71 g/dL (SD=0.57) of group 2; p-value <0.0001. Transfusion rate in group 1 was found to be 1.9%, compared to 4.9% in group 2; p-value=0.009. Total blood loss was found to be 714.6 mL (SD=410.4) in group 1, compared to 911.8 mL (SD=529.7) in group 2; p-value <0.0001. Conclusions: The present review has shown that TXA administration in shoulder arthroplasty has effectively reduced blood loss, postoperative hemoglobin decline and need for transfusion. More research is needed, since optimization of route, timing and dosage of TXA remain to be determined. [ABSTRACT FROM AUTHOR]

Introduction: Incidence of hip fractures is increasing with upward estimates representing one of the most current health problems. According to some authors this condition is associated with an early mortality rate ranging between 20% and 35% and low outcomes. One of the predictive factors of poor outcome after hip fracture is anaemia. In fragile patients, hormonal changes due to fracture and surgical trauma, may occur in the hypophyseal hypothalamus axis which may lead to the Euthyroid Sick Syndrome (ESS). This pathological condition is characterized by a reduction in the concentration of triiodothyronine (T3) with normal or slightly reduced thyrotropin (TSH) values and with or without a reduction (cancellata) ​​of thyroxine (T4). ESS has been associated to an increased mortality in elderly patients.Materials and Methods: Inclusion criteria were: age > 65y, X-ray diagnosis of proximal femoral fracture classified as AO 31A or 31B requiring surgical treatment, admittance to the emergency room within 72 hours from trauma. Exclusion criteria were: any thyroid-related pathology, concomitant acute coronary syndrome, active pneumonia, concomitant neoplastic disease, assumption of medications able to affect thyroid function, refusal to undergo surgical treatment. All patients underwent routine blood testing and a complete thyroid-hormone profile dosage before surgical operation. The same blood tests performed before surgical operation were repeated on the first and third post-operative days.Results: Thirtytwo patients met the inclusion criteria and were enrolled after they accepted to participate to the study. Sixteen patients presented with ESS on admission and 16 patients did not. The mean age was 82,5 yo. There was no statistically significant difference in bleeding risk factors among the two groups. In the ESS group there was a number of blood transfusions of 1.06 units higher than the control group (p=0.01).Conclusions: We have demonstrated that patients with ESS have a higher need of red blood cells  transfusion compared to patients without ESS and, thus they have a higher risk to develop anemia in the peri-operative period. We believe it would be useful to diagnose ESS in fragile patients at their arrival to the emergency room and apply a peri-operative therapeutic protocol to prevent anemia. [ABSTRACT FROM AUTHOR]

Introduction: Every year more than 300,000 proximal femur fractures are diagnosed. Their number will double within 30 years. In femoral neck fractures treated with hip hemiarthroplasty 90-days mortality is 29.5-51.6%. Haemorrhage is one amongst other complications that is associated with increasing postoperative mortality. Transfusion rate in these patients ranges from 25.7% to 39%. Blood transfusions expose to complications. Fibrin sealants are useful in reducing perioperative need for transfusions, total blood loss, blood loss from drainage. The aim of this study is to assess whether the use of a fibrin sealant during hip hemiarthroplasty implant reduces the need for transfusion.Patient and Methods: All patients admitted with a proximal femur fracture from September 2018 to May 2019 were reviewed. Inclusion criteria were: femoral neck fracture AO 31B2-3, hip hemiarthroplasty. Exclusion criteria were: previous surgery on the affected hip, coagulation disorders, hematopoietic disorders. Patients were divided in fibrin sealant group and control group. All patients underwent partial hip replacement through a posterolateral approach. 4 ml of fibrin sealant (EVICEL, Omrix Biopharmaceuticals, Diegem, Belgium) were sprayed on the soft tissues of patients included in the fibrin sealant group. Primary outcome of our study was need for perioperative transfusion. Secondary outcomes were: mean red blood cell transfused volume, variations in haematocrit and haemoglobin and total blood volume loss.Results: Eighty-one consecutive patients were enrolled. EVICEL was used on 19 patients, standard haemostatic care on 62 patients. Two patients were transfused in the fibrin sealant group, 22 in the control group (p 0,0371). Mean transfused volume was 21,05 ml in the fibrin sealant group and 116,16 ml in the control group (p 0,0017). No significant difference could be found in haematocrit and haemoglobin variation and total blood loss.Discussion: A reduction in transfusional need with the use of fibrin sealants was reported in studies on total hip arthroplasty and was confirmed by our study.Conclusion: EVICEL reduces need for transfusion in patients undergoing hip hemiarthroplasty for a femoral neck fracture. It must be held among the options when a stricter control on transfusional requirement is needed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Tranexamic acid (TXA) and the hemostatic agent Floseal® have already been used to minimize bleeding during total knee arthroplasty (TKA). METHODS: We conducted a prospective, randomized study of 90 patients with indications for TKA. Following inclusion, the participants were randomly allocated in blocks to the following 3 groups: control, Floseal® and TXA. Bleeding parameters, including decreases in hemoglobin (Hb), drain output, number of blood transfusions and complications, were assessed. ClinicalTrials.gov: NCT02152917. RESULTS: The mean decrease in Hb was highest in the control group (4.81±1.09 g/dL), followed by the Floseal® (3.5±1.03 g/dL) and TXA (3.03±1.2 g/dL) groups. The Floseal® and TXA groups did not differ, and both performed better than the control group. The mean total drain output was 901.3±695.7 mL in the control group, 546.5±543.5 mL in the TXA group and 331.2±278.7 mL in the Floseal® group. Both TXA and Floseal® had significantly less output than the control group, and Floseal® had significantly less output than TXA. The number of blood transfusions was very small in all 3 groups. CONCLUSION: The use of TXA or Floseal® was associated with less blood loss than that of the control group among patients undergoing primary TKA, as measured both directly (intraoperative bleeding + drainage) and on the basis of a decrease in Hb, without differences in the rate of complications. TXA and Floseal® showed similar decreases in Hb and total measured blood loss, but the drain output was smaller in the Floseal® group.

We have conducted a prospective randomized study to determine the effect of intravenous or local administration of tranexamic acid (TXA) in perioperative transfusion rates, hospital stay and overall hospitalization costs in patients underwent total knee (TKA) or total hip (THA) arthroplasty. During 2015- 2016, 125 THA and 124 TKA consecutive patients were randomly allocated to receive low dose TXA either intravenously (ivTXA groups) or local administration (locTXA groups) or to serve as controls. Power analysis showed that 41 patients in each group were required in order to have an 80% probability of demonstrating a between surgeries difference of more than 35%. Full blood counts obtained on the first and third postoperative day and the maximum hemoglobin difference was documented in all patients. The costs of hospitalization, transfusions and TXA were retrieved by the hospital financial administration. All groups were homogenic in regards to age and preoperative Hgb levels. In both THA and TKA patients, a statistically significant reduction in the maximum hemoglobin difference was found for both the intravenous (ivTXA) and local application (locTXA) groups compared to controls (P

BACKGROUND: The effect of tranexamic acid on hemostasis in total hip arthroplasty has been recognized by more and more scholars. However, its safe and effective application still remains controversial. OBJECTIVE: To compare the efficacy about intravenous infusion and topical application concerning tranexamic acid in the primary unilateral total hip arthroplasty. METHODS: Cochrane Library, PubMed, Embase, CNKI and WanFang databases were retrieved for the articles published before November 2018. For discovering all the required literature, all relevant papers and references in the included literature were consulted. All the papers included were strictly assessed by selection as well as exclusion criteria, in order to evaluate their conformity with the project and their quality. Finally, a meta-analysis of eligible studies was conducted. RESULTS AND CONCLUSION: (1) Nine eligible studies were included (improved Jadad score ≥ 4 points) discussed by 3 researchers. (2) This study showed that intravenous infusion had an advantage over local application [WMD=-4.08, 95%CI (-5.99, -2.17), P < 0.01] on the effect of tranexamic acid reducing the postoperative change of hemoglobin. (2) No significant difference occurred between intravenous infusion and local application in total perioperative blood loss [WMD=-26.10, 95%CI (-56.96, 4.76), P=0.10], transfusion rate [RR=0.92, 95%CI (0.62, 1.35), P=0.66], postoperative risk of deep venous thrombosis in lower extremities [RR=1.26, 95%CI (0.34, 4.65), P=0.72], postoperative risk of pulmonary embolism [RR=2.96, 95%CI (0.12, 71.38), P=0.50] and postoperative incidence of incision complications [RR=0.78, 95%CI (0.40, 1.52), P=0.47]. (4) In summary, tranexamic acid with intravenous infusion can reduce perioperative hemoglobin changes, with no increase in postoperative risk of deep venous thrombosis in lower extremities, pulmonary embolism and poor incision healing. As a result, tranexamic acid in intravenous infusion is recommended when primary unilateral hip arthroplasty is conducted. [ABSTRACT FROM AUTHOR]

Abstract Introduction Blood loss in Total Joint Arthroplasty can be significant and often under-estimated. This study aims to investigate the safety and efficacy of different routes of tranexamic acid (TXA) administration in reducing blood transfusion after Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). The secondary aim is to find the safest and most efficacious route and dose of TXA. Material and methods PubMed, Embase, Cochrane library, China National Knowledge Infrastructure, and OpenGrey were systemically searched for randomised controlled trials investigating the efficacy and/or safety of TXA for THA and/or TKA. Network meta-analysis, comparing the number of transfusion and deep vein thrombosis (DVT) among different interventions, was performed using a multivariate meta-regression model with random-effects, adopting a frequentist approach. Results 211 publications (20,639 individuals) were included. For outcome of transfusion, all interventions showed significantly lower transfusion rates compared to placebo. When compared to placebo, TXA via intra-venous and topical showed statistically significant lowest risk ratio (RR = 0.11, 95CI: 0.03, 0.41). For safety, TXA via topical showed relatively lowest risk ratio (RR = 0.75, 95CI 0.44, 1.30). TXA via topical and intra-articular had the highest but statistically insignificant RR (RR = 1.10, 95%CI: 0.51, 2.38). Therefore, current studies did not reveal any significant safety issue in using TXA. Conclusion All forms of TXA administration showed significantly lower transfusion rate compared to control. There is a trend towards better efficacy with intra-venous and topical. In patients with higher risk of thrombosis, physicians may consider topical alone for its best safety profile. Highlights • Tranexamic acid administration via intra-venous together with topical provides the best efficacy to prevent transfusion. • Current studies did not reveal any significant increased risk of thrombosis in any mode of administration of tranexamic acid. • Tranexamic acid administration via topical alone has the best safety profile. [ABSTRACT FROM AUTHOR]

The use of closed-suction drainage systems after total knee arthroplasty (TKA) is common practice in India, but with no consensus on its use. In this retrospective study, we compared whether clamped or unclamped drainage has any advantages over the other in unilateral TKA. Group-A (n = 351) had an unclamped drain removed at 24 h postoperative, with measurement of total drainage at 24 h between January 2011 and February 2013. Group B (n = 349) had drains kept for a total of 8 h-clamped for the first 4 h and unclamped for a further 4, between March 2013 to September 2016. Drainage volume, as well as the hemodynamic markers-hemoglobin (Hb) drop, transfusion rate were evaluated. Mean drain output in Group- A was significantly higher than Group- B (215.64 ml versus 28.34 ml). The postoperative Hb was significantly higher in Group-B (11.46 g/dl versus 10.57 g/dl). Mean Hb drop was significantly higher in Group A (2.16 g/dl versus 1.18 g/dl). The transfusion rates were lower in Group-B, though not statistically significant. The 4- hour clamping method effectively reduces drain output and fall in hemoglobin. For those who continue using closed suction drains, clamping could prove to be an effective way of reducing post-operative blood loss and the need for transfusions. [ABSTRACT FROM AUTHOR]

Purpose: Little scientific evidence on blood loss and transfusion rates after short-stem hip arthroplasty exists. The hypothesis of this study was that the blood loss and transfusion rate is lower in short stems compared to straight stems.Methods: We compared 124 patients who underwent total hip arthroplasty (THA) using a short-stem design (group 1) and 141 patients using a straight-stem design (group 2). All patients were operated on by the same surgeon, and both groups were similar in age, gender, affected side, body mass index, and ASA score.Results: The calculated blood loss was 1139 ml in group 1 and 1358 ml in group 2 (p < 0.001). The transfusion rate was 8% in group 1 and 15.6% in group 2 (p < 0.001). There was no significant difference between groups 1 and 2 regarding complications and operation time (p > 0.05).Conclusion: Compared to patients after straight stem THA, both blood loss and blood transfusion rates were lower in patients after short stem THA. [ABSTRACT FROM AUTHOR]