Thromboembolic event index after total knee arthroplasty with the use of tranexamic acid: an integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i15.37094

Keywords:

Knee; Arthroplasty; Thromboembolism; Tranexamic acid.

Abstract

Total knee arthroplasty (TKA) is a surgical procedure that consists of replacing the weight-bearing surfaces of the affected joint with a prosthesis, aiming at relieving pain and correcting deformities. Due to the inherent risk of venous thromboembolism, drugs are used for its prophylaxis. This integrative literature review aimed to analyze the complications involved in the use of tranexamic acid in patients undergoing total knee arthroplasty (TKA), specifically the thromboembolic events that occurred. Studies were selected from PubMed, SciELO, Medline and Thieme electronic databases. Eleven randomized clinical trials were included. The total number of patients included in the studies was 1.299 who underwent TKA. In total, seven thromboembolic events were recorded, thus occurring in 0.5% of the cases analyzed. Thus, the safety of the use of tranexamic acid is proven, so that 99.5% of the patients did not present thromboembolic events, with the index relative to positive cases being practically irrelevant. Thus, the concluion is that the drug is safe and effective to be used in this surgical procedure, in order to minimize bleeding, rarely resulting in thromboembolic events.

References

Albuquerque, L., Silveira, F., Zago, A., Bettio, J., Petracco, J., & Alegre, P. (1997). Terapia Trombolítica em Trombose Venosa Profunda. Experiência Clínica Inicial Comunicações Breves. Arq Bras Cardiol, 68(2), 125–128. http://publicacoes.cardiol.br/abc/1997/6802/68020011.pdf

Alves Júnior, W. M., Migon, E. Z., & Zabeu, J. L. A. (2010). Dor no joelho após artroplastia total - uma abordagem sistematizada. Revista Brasileira de Ortopedia, 45, 384–391. https://doi.org/10.1590/S0102-36162010000500002

Bin Abd Razak, H. R., Binte Abd Razak, N. F., & Tan, H.-C. A. (2017). Prevalence of Venous Thromboembolic Events Is Low in Asians After Total Knee Arthroplasty Without Chemoprophylaxis. The Journal of Arthroplasty, 32(3), 974–979. https://doi.org/10.1016/j.arth.2016.09.008

Blanchard, J., Meuwly, J. Y., Leyvraz, P. F., Miron, M. J., Bounameaux, H., Hoffmeyer, P., Didier, D., & Schneider, P. A. (1999). Prevention of deep-vein thrombosis after total knee replacement. Randomised comparison between a low-molecular-weight heparin (nadroparin) and mechanical prophylaxis with a foot-pump system. The Journal of Bone and Joint Surgery. British Volume, 81(4), 654–659. https://doi.org/10.1302/0301-620x.81b4.9464

Boström, J., Grant, J. A., Fjellström, O., Thelin, A., & Gustafsson, D. (2013). Potent Fibrinolysis Inhibitor Discovered by Shape and Electrostatic Complementarity to the Drug Tranexamic Acid. Journal of Medicinal Chemistry, 56(8), 3273–3280. https://doi.org/10.1021/jm301818g

Bredbacka, S., Andreen, M., Blombäck, M., & Wykman, A. (1987). Activation of cascade systems by hip arthroplasty. No difference between fixation with and without cement. Acta Orthopaedica Scandinavica, 58(3), 231–235. https://doi.org/10.3109/17453678709146472

Eriksson, B. I., Eriksson, E., Gyzander, E., Teger-nilsson, A.-C., & Risberg, B. (1989). Thrombosis after hip replacement: Relationship to the fibrinolytic system. Acta Orthopaedica Scandinavica, 60(2), 159–163. https://doi.org/10.3109/17453678909149244

Francis, C. W., Ricotta, J. J., Evarts, C. M., & Marder, V. J. (1988). Long-term clinical observations and venous functional abnormalities after asymptomatic venous thrombosis following total hip or knee arthroplasty. Clinical Orthopaedics and Related Research, 232, 271–278. https://pubmed.ncbi.nlm.nih.gov/3383492/

Franco, R. F. (2001). Fisiologia da coagulação, anticoagulação e fibrinólise. Medicina (Ribeirão Preto), 34(3/4), 229–237. https://doi.org/10.11606/issn.2176-7262.v34i3/4p229-237

Gali, J., & Camargo, D. (2019). Tromboprofilaxia na artroplastia total do joelho. Revista Brasileira de Ortopedia, 54(01), 001–005. https://doi.org/10.1016/j.rbo.2017.06.025

Huang, Z., Xie, X., Li, L., Huang, Q., Ma, J., Shen, B., Kraus, V. B., & Pei, F. (2017). Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial. The Journal of Bone and Joint Surgery. American Volume, 99(24), 2053–2061. https://doi.org/10.2106/JBJS.16.01525

Jansen, A. J., Andreica, S., Claeys, M., D’Haese, J., Camu, F., & Jochmans, K. (1999). Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. British Journal of Anaesthesia, 83(4), 596–601. https://doi.org/10.1093/bja/83.4.596

Jeter, E. K., & Spivey, M. A. (1995). Noninfectious Complications of Blood Transfusion. Hematology/Oncology Clinics of North America, 9(1), 187–204. https://doi.org/10.1016/s0889-8588(18)30116-3

Lee, S. Y., Chong, S., Balasubramanian, D., Na, Y. G., & Kim, T. K. (2017). What is the Ideal Route of Administration of Tranexamic Acid in TKA? A Randomized Controlled Trial. Clinical Orthopaedics & Related Research, 475(8), 1987–1996. https://doi.org/10.1007/s11999-017-5311-z

Morales Santias, M., Mas Martinez, J., Sanz-Reig, J., Martínez Gimenez, E., Verdu Román, C., & Bustamante Suarez de Puga, D. (2020). Topical tranexamic acid in cemented primary total knee arthroplasty without tourniquet: a prospective randomized study. European Journal of Orthopaedic Surgery & Traumatology, 30(6), 1003–1008. https://doi.org/10.1007/s00590-020-02656-9

Orpen, N. M., Little, C., Walker, G., & Crawfurd, E. J. P. (2006). Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: A prospective randomised controlled trial of 29 patients. The Knee, 13(2), 106–110. https://doi.org/10.1016/j.knee.2005.11.001

Padala, P., Rouholamin, E., & Mehta, R. (2010). The Role of Drains and Tourniquets in Primary Total Knee Replacement – A Comparative Study of TKR Performed With Drains and Tourniquet Versus No Drains and Adrenaline and Saline Infiltration. The Journal of Knee Surgery, 17(01), 24–27. https://doi.org/10.1055/s-0030-1247143

Roy, N., Smith, M., Anwar, M., & Elsworth, C. (2006). Delayed release of drain in total knee replacement reduces blood loss. A prospective randomised study. Acta Orthopaedica Belgica, 72(1), 34–38. https://pubmed.ncbi.nlm.nih.gov/16570892/

Silva, C. C., Savian, C. M., Prevedello, B. P., Zamberlan, C., Dalpian, D. M., & Santos, B. Z. dos. (2020). Access and use of dentalservices by pregnant women: An integrative literature review. Ciencia e Saude Coletiva, 25(3), 827–835.https://doi.org/10.1590/1413-81232020253.01192018

Souza, M. T., Silva, M. D., & Carvalho, R. (2010). Integrative review: what is it? How to do it? Einstein (São Paulo),8(1), 102–106.https://doi.org/10.1590/s1679-45082010rw1134

Spanyer, J., Patel, J., Emberton, E., Smith, L., & Malkani, A. (2016). Topical Tranexamic Acid in Total Knee Arthroplasty Patients with Increased Thromboembolic Risk. The Journal of Knee Surgery, 30(05), 474–478. https://doi.org/10.1055/s-0036-1593371

Tille, E., Mysliwietz, J., Beyer, F., Postler, A., & Lützner, J. (2019). Intraarticular use of tranexamic acid reduces blood loss and transfusion rate after primary total knee arthroplasty. BMC Musculoskeletal Disorders, 20(1). https://doi.org/10.1186/s12891-019-2715-9

Volquind, D., Zardo, R. A., Winkler, B. C., Londero, B. B., Zanelatto, N., & Leichtweis, G. P. (2016). Uso do ácido tranexâmico em artroplastia total primária de joelho: repercussões na perda sanguínea perioperatória. Brazilian Journal of Anesthesiology, 66(3), 254–258. https://doi.org/10.1016/j.bjan.2014.11.002

Wang, D., Luo, Z.-Y., Yu, Z.-P., Liu, L.-X., Chen, C., Meng, W.-K., Yu, Q.-P., Pei, F.-X., Zhou, Z.-K., & Zeng, W.-N. (2018). The antifibrinolytic and anti-inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial. Journal of Thrombosis and Haemostasis, 16(12), 2442–2453. https://doi.org/10.1111/jth.14316

Zekcer, A., Del Priori, R., Tieppo, C., Silva, R. S. da, & Severino, N. R. (2016). Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial. Jornal Vascular Brasileiro, 15(2), 120–125. https://doi.org/10.1590/1677-5449.007515

Zhang, S., Wang, C., Shi, L., & Xue, Q. (2019). Multi-route applications of tranexamic acid to reduce blood loss after total knee arthroplasty. Medicine, 98(30), e16570. https://doi.org/10.1097/md.0000000000016570

Downloads

Published

13/11/2022

How to Cite

ALVES, R. R. G.; EUSTÁQUIO, J. M. J.; GOMES, S. M. P.; MORAIS, M. L. O.; MORAIS, J. C. O.; SACARDO, A. V.; PARREIRA, E. R. Thromboembolic event index after total knee arthroplasty with the use of tranexamic acid: an integrative review . Research, Society and Development, [S. l.], v. 11, n. 15, p. e160111537094, 2022. DOI: 10.33448/rsd-v11i15.37094. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/37094. Acesso em: 25 apr. 2024.

Issue

Section

Review Article