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      Comment on the intravenous tranexamic acid use in revision total joint arthroplasty

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      Drug Design, Development and Therapy

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          Abstract

          Dear editor Kuo et al thoroughly evaluated the safety and efficacy of intravenous tranexamic acid in revision total joint arthroplasty (TJA) via aspects of blood loss and transfusion, events of venous thromboembolism.1 We consider application of this drug of great value in revision TJA. However, we would like to address several concerns related to this meta-analysis. First, the conclusion of no increased risk of venous thromboembolism was drawn through assessment of five studies, according to the description in the context, yet data of only two studies were extracted in Figure 6, in the form of a forest plot. We carefully read the other five studies selected in this meta-analysis, and found three more of them that contained data of thromboembolic events.2–4 Two of them showed favorable results for no related event occurrence,2,3 and the third found increased incidence of thrombotic complications without statistical significance (P=0.3).4 We suggest these results should be included in the analysis, so as to raise the reliability of this conclusion. Second, there were some deficiencies in the literature search. Only three electronic databases (PubMed, Scopus, and Cochrane Central Register of Controlled Trials) were systematically searched. The small number of studies included might be a limitation of this meta-analysis. Since most of the investigators came from China, a more comprehensive search should also include Chinese databases, such as CBM on Disc and CNKI. We appreciate the investigators’ contribution in supplying us with an excellent safety and efficacy evaluation of intravenous tranexamic acid in revision TJA. If possible, we hope the investigators can make proper revisions to this meta-analysis to make it more credible. Moreover, for the disadvantages of unavoidable risk of bias caused by the limited number of qualified clinical trials or retrospective studies, further prospective randomized controlled trials are required, just as the investigators pointed out in the conclusion.

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          Effectiveness of tranexamic acid in revision total knee arthroplasty.

          The effectiveness of Tranexamic Acid (TXA, antifibrinolytic drug) in reducing allogeneic blood transfusion requirements has not been tested in revision total knee arthroplasty. The aim of this study was to assess the effectiveness of TXA after two intravenous doses of 1 g each. Between April 2006 and February 2010, 68 consecutive patients (19 male, 49 female) of 74 +/- 6 [m +/- SD] years of age were included and divided into three groups: control (28 patients), in which TXA was not administered but was not contraindicated; TXA (19 patients) who received TXA, and NO-TXA (21 patients), who were not administered TXA because of a contraindication. The proportions of patients transfused were 54%, 32% and 62% respectively in the control, TXA and NO-TXA group; the median numbers of RBC units transfused were respectively 2 [range: 1-4], 2 [range: 2-2] and 2.5 [range: 1-5], (p = 0.057). Mean total estimated blood loss was 1693 mL (SD: 689) in the control group, 1196 mL (SD: 665) in the TXA group and 2454 mL (SD: 2166) in the NO-TXA group, (p = 0.015). No adverse events were reported. TXA administration appeared as an effective and safe means of reducing blood transfusion requirements and blood loss in revision total knee arthroplasty.
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            The effect of bolus administration of tranexamic acid in revision hip arthroplasty

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              Tranexamic Acid Reduces Blood Transfusions in Revision Total Hip Arthroplasty

              The use of tranexamic acid (TEA) can significantly reduce the need for allogenic blood transfusions in elective primary joint arthroplasty. Revision total hip arthroplasty (THA) requires increased utilization of postoperative blood transfusions for acute blood loss anemia compared with elective primary hip arthroplasty. There is limited literature to support the routine use of TEA in revision THA.
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                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                1177-8881
                2018
                10 December 2018
                : 12
                : 4191-4194
                Affiliations
                Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha 410011, China, liuyoushuo@ 123456yeah.net
                [1 ]Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
                [2 ]Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
                [3 ]Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, afchen@ 123456bwh.harvard.edu
                Author notes
                Correspondence: Youshuo Liu, Department of Geriatrics, Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha, 410011, China, Tel +86 731 8529 5678, Email liuyoushuo@ 123456yeah.net
                Correspondence: Antonia F Chen, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA, Tel +1 617 525 5935, Fax +1 617 264 5226, Email afchen@ 123456bwh.harvard.edu
                Article
                dddt-12-4191
                10.2147/DDDT.S188844
                6292392
                © 2018 He and Liu. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Letter

                Pharmacology & Pharmaceutical medicine

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