Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplasty
Abstract Background Questions remain, mainly concerning whether tranexamic acid (TXA) is truly safe since all available trials were underpowered to identify clinically important differences. The objective of this study is to evaluate the safety of TXA by using a novel technique—thromboelastography (...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-019-1250-6 |
| _version_ | 1798042628050124800 |
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| author | Xiang-Dong Wu Yu Chen Mian Tian Yao He Yu-Zhang Tao Wei Xu Qiang Cheng Cheng Chen Wei Liu Wei Huang |
| author_facet | Xiang-Dong Wu Yu Chen Mian Tian Yao He Yu-Zhang Tao Wei Xu Qiang Cheng Cheng Chen Wei Liu Wei Huang |
| author_sort | Xiang-Dong Wu |
| collection | DOAJ |
| description | Abstract Background Questions remain, mainly concerning whether tranexamic acid (TXA) is truly safe since all available trials were underpowered to identify clinically important differences. The objective of this study is to evaluate the safety of TXA by using a novel technique—thromboelastography (TEG). Methods A retrospective review was conducted on 359 consecutive patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) and received multiple-dose or single-dose of TXA at a tertiary academic center. TEG parameters, TEG coagulation status, conventional coagulation test parameters, and incidence of thrombotic events were used for safety evaluation. Results Compared with single-dose cohort, patients who received multiple-dose of TXA had consistent statistically significant shortened R times on post-operative day 1 (POD1) and POD3 in both THA (POD1: 4.06 ± 0.71 s versus 4.45 ± 1.28 s, P = 0.011; POD3: 4.36 ± 0.83 s versus 5.12 ± 1.64 s, P < 0.0001) and TKA (POD1: 3.90 ± 0.73 s versus 4.29 ± 0.92 s, P = 0.011; POD3: 4.24 ± 0.94 s versus 4.65 ± 1.07 s, P = 0.023), while the K, α-angle, and MA values were similar during the perioperative period. TEG coagulation status analysis indicated that patients were significantly (P = 0.003) more likely with hypercoagulable status during the course of multiple-dose TXA. Conventional coagulation test parameters were similar. Only one patient developed calf vein thrombosis in the multiple-dose cohort. Conclusions Multiple-dose of TXA was associated with aggravated hypercoagulable state when compared with single-dose of TXA, but this prothrombotic state does not provoke thrombosis when combined with appropriate anticoagulant therapy. Therefore, multiple-dose of TXA remains safe and could be recommended for clinical practice. Potential benefits and possible risks should be trade-off when considering increasing the dosage and frequency of TXA on the present basis. Trial registration ChiCTR1800015422. |
| first_indexed | 2024-04-11T22:38:05Z |
| format | Article |
| id | doaj.art-e4c8de57961440b48de0734aa762ef5f |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T22:38:05Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-e4c8de57961440b48de0734aa762ef5f2022-12-22T03:59:10ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2019-07-0114111010.1186/s13018-019-1250-6Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplastyXiang-Dong Wu0Yu Chen1Mian Tian2Yao He3Yu-Zhang Tao4Wei Xu5Qiang Cheng6Cheng Chen7Wei Liu8Wei Huang9Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical UniversityAbstract Background Questions remain, mainly concerning whether tranexamic acid (TXA) is truly safe since all available trials were underpowered to identify clinically important differences. The objective of this study is to evaluate the safety of TXA by using a novel technique—thromboelastography (TEG). Methods A retrospective review was conducted on 359 consecutive patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) and received multiple-dose or single-dose of TXA at a tertiary academic center. TEG parameters, TEG coagulation status, conventional coagulation test parameters, and incidence of thrombotic events were used for safety evaluation. Results Compared with single-dose cohort, patients who received multiple-dose of TXA had consistent statistically significant shortened R times on post-operative day 1 (POD1) and POD3 in both THA (POD1: 4.06 ± 0.71 s versus 4.45 ± 1.28 s, P = 0.011; POD3: 4.36 ± 0.83 s versus 5.12 ± 1.64 s, P < 0.0001) and TKA (POD1: 3.90 ± 0.73 s versus 4.29 ± 0.92 s, P = 0.011; POD3: 4.24 ± 0.94 s versus 4.65 ± 1.07 s, P = 0.023), while the K, α-angle, and MA values were similar during the perioperative period. TEG coagulation status analysis indicated that patients were significantly (P = 0.003) more likely with hypercoagulable status during the course of multiple-dose TXA. Conventional coagulation test parameters were similar. Only one patient developed calf vein thrombosis in the multiple-dose cohort. Conclusions Multiple-dose of TXA was associated with aggravated hypercoagulable state when compared with single-dose of TXA, but this prothrombotic state does not provoke thrombosis when combined with appropriate anticoagulant therapy. Therefore, multiple-dose of TXA remains safe and could be recommended for clinical practice. Potential benefits and possible risks should be trade-off when considering increasing the dosage and frequency of TXA on the present basis. Trial registration ChiCTR1800015422.http://link.springer.com/article/10.1186/s13018-019-1250-6Multiple-doseSafetyThromboelastographyTotal hip arthroplastyTotal knee arthroplastyTranexamic acid |
| spellingShingle | Xiang-Dong Wu Yu Chen Mian Tian Yao He Yu-Zhang Tao Wei Xu Qiang Cheng Cheng Chen Wei Liu Wei Huang Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplasty Journal of Orthopaedic Surgery and Research Multiple-dose Safety Thromboelastography Total hip arthroplasty Total knee arthroplasty Tranexamic acid |
| title | Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplasty |
| title_full | Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplasty |
| title_fullStr | Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplasty |
| title_full_unstemmed | Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplasty |
| title_short | Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplasty |
| title_sort | application of thrombelastography teg for safety evaluation of tranexamic acid in primary total joint arthroplasty |
| topic | Multiple-dose Safety Thromboelastography Total hip arthroplasty Total knee arthroplasty Tranexamic acid |
| url | http://link.springer.com/article/10.1186/s13018-019-1250-6 |
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