One Dose of Intravenous Tranexamic Acid in Total Joint Arthr
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A single formulation of tranexamic acid (TXA) has been agreed on for total joint arthroplasty. The purpose of this study is to compare previously uninvestigated single-dose and two-dose regimens in postoperative hemoglobin level and secondary outcomes within 30 days of surgery.

A retrospective search of patients who underwent primary total knee arthroplasty and primary total hip arthroplasty was performed. Patients were divided into two groups: one group received a 1-g bolus of intravenous TXA just before incision and another intravenous 1-g bolus during wound closure, and the second group received a single 1-g intravenous bolus of TXA just before incision. Two doses of TXA were administered in 873 procedures, and a single dose was administered in 647 procedures.

Results:
--A single intravenous TXA dose just before incision was comparable with using two doses of intravenous TXA on patients' postoperative hemoglobin value, length of stay, rate of transfusion, and 30-day postoperative complication rate, although those receiving two doses of TXA trended toward being less likely to require a transfusion.

--A sensitivity analysis was unable to identify a preoperative hemoglobin value that would identify whether patients would benefit from two versus one dose of TXA.

In particular, the use of a single intravenous TXA dose was as efficacious as two doses, without an increase in postoperative complications.

Source: https://journals.lww.com/jaaos/Abstract/2021/06010/One_Dose_Versus_Two_Doses_of_Intravenous.10.aspx
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