Journal CME - 2017 September
Back to Journal CME - 2017 September
Journal CME - 2017 September

Journal CME - 2017 September


Background: Preoperative administration of the antifibrinolytic agent tranexamic acid reduces bleeding in patients undergoing hip arthroplasty. Increased fibrinolytic activity is maintained throughout the first day postoperation. The objective of the
study was to determine whether additional perioperative administration of tranexamic acid would further reduce blood loss.

Methods: This prospective, double-blind, parallel-arm, randomized, superiority study was conducted in 168 patients undergoing unilateral primary hip arthroplasty. Patients received a preoperative intravenous bolus of 1 g of tranexamic acid followed by a continuous infusion of either tranexamic acid 1 g (bolus-plus-infusion group) or placebo (bolus group) for 8 h. The primary outcome was calculated perioperative blood loss up to day 5. Erythrocyte transfusion was implemented according to a restrictive transfusion trigger strategy.

Results: The mean perioperative blood loss was 919 ± 338 ml in the bolus-plus-infusion group (84 patients analyzed) and 888 ± 366 ml in the bolus group (83 patients analyzed); mean difference, 30 ml (95% CI, -77 to 137; P = 0.58). Within 6 weeks postsurgery, three patients in each group (3.6%) underwent erythrocyte transfusion and two patients in the bolus group experienced distal deep-vein thrombosis. A meta-analysis combining data from this study with those of five other trials showed no incremental efficacy of additional perioperative administration of tranexamic acid.

Conclusions: A preoperative bolus of tranexamic acid, associated with a restrictive transfusion trigger strategy, resulted in low erythrocyte transfusion rates in patients undergoing hip arthroplasty. Supplementary perioperative administration of tranexamic acid did not achieve any further reduction in blood loss.

CME Credit: 1.00 AMA PRA Category 1 Credit

Required Hardware / Software:
Adobe Acrobat Reader, Internet connection. Web browser version must have been released within the last three years.

Activity Release Date:

Activity Expiration Date:

  • List Price: $20.00
  • Member Price: Free
Want to save more?
Log into see if you qualify for a lower rate.
Members save $20.00 or more Join
Item Details:

Learning Objectives: After successfully completing this activity, the learner will be able to:

- Inform patients of the benefits of using tranexamic acid (TXA) to reduce blood loss (1, 3)
- Determine the best method of TXA administration for a specific patient during hip surgery (4, 5, 6)
- Advise...

Back to Journal CME - 2017 September
View More View Less
Back to Product Detail
There are not any reviews for this product.

Thank You Industry Supporters

Whose contributions allow the American Society of Anesthesiologists® to create world-class education and resources to improve patient care and outcomes.

Learn More