Randomized Controlled Trial of Tranexamic Acid in Total Knee Arthroplasty: Intravenous vs. Topical
8. november 2019 opdateret af: Hospital for Special Surgery, New York
The purpose of this study is to determine whether topical or intravenous administration of tranexamic acid during unilateral total knee replacement is more effective at reducing bleeding in the first 24 hours following surgery.
Tranexamic acid is a synthetic drug that has been shown to reduce blood drain output and the need for blood transfusions in both its topical and intravenous forms and is commonly used in orthopedic surgery.
We hypothesize that IV and topical administration of tranexamic acid will be equally good at reducing the loss of blood and the need for transfusion immediately following total knee replacement.
Studieoversigt
Status
Afsluttet
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
This randomized controlled trial compares the blood loss of patients undergoing unilateral total knee replacements who randomly receive either the topical or the intravenous form of tranexmamic acid during surgery. Patients in the intravenous arm of the study will receive 1 gram of tranexamic acid in 10 milliliters of solution prior to inflation of the tourniquet and 1 gram of tranexamic acid in 10 milliliters of solution during closure. For patients in the topical arm of the study, prior to the release of the tourniquet they will receive 3 grams of tranexamic acid in 75ccs of solution directly on the site of the incision.
The primary result measurement will be blood drain output from the knee at 24 hours after surgery.
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
640
Fase
- Fase 4
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
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Minnesota
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Rochester, Minnesota, Forenede Stater, 55902
- Mayo Clinic
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New York
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New York, New York, Forenede Stater, 10021
- Hospital for Special Surgery
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Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år til 100 år (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
Inclusion Criteria:
- Primary total knee replacmeent
- Osteoarthritis
- Unilateral
Exclusion Criteria:
- Revision surgery
- Donated preoperative autologous blood
- On chronic anticoagulation medication such as Coumadin, Xarelto, Plavix, or Aspirin (other than 81mg)
- Preoperative hepatic or renal dysfunction
- Diagnosis of inflammatory disease
- Diagnosis of inflammatory arthritis
- Pregnant
- Breastfeeding
- Preoperative hemoglobin <10g/dL
- International Normalized Ratio>1.4
- Abnormal Partial Thromboplastin Time
- Preoperative platelet count of <150,000mm^3
- Creatinine > 1.4
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Tredobbelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
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Aktiv komparator: Topical Tranexamic Acid
3 vials of tranexamic acid (1g tranexamic acid in 10cc each) must be mixed in the operating room by the team at the start of surgery with 45cc of saline solution (for a total of 3g tranexamic acid in 75mL solution).
This solution will be applied to the open joint surfaces with two 60mL syringes (one with 60mL and one with 15m).
The solution will be left in contact with the tissues for five minutes.
The surgeon will suction away excess solution.
The site may be irrigated before or after the tranexamic acid bath as long as the solution is in contact for at least five full minutes.
After that, the tourniquet will be released and the rest of the surgery will proceed according to the standard of care.
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3 vials of tranexamic acid (1g tranexamic acid in 10cc each) must be mixed in the operating room by the team at the start of surgery with 45cc of saline solution (for a total of 3g tranexamic acid in 75mL solution).
This solution will be applied to the open joint surfaces with two 60mL syringes (one with 60mL and one with 15m).
The solution will be left in contact with the tissues for five minutes.
The surgeon will suction away excess solution.
The site may be irrigated before or after the tranexamic acid bath as long as the solution is in contact for at least five full minutes.
After that, the tourniquet will be released and the rest of the surgery will proceed according to the standard of care.
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Aktiv komparator: Intravenous Tranexamic Acid
1 vial (1g of IV tranexamic acid in 10mL solution) will be administered prior to inflation of the tourniquet.
A second 1g dose of IV tranexamic acid will be given during initiation of the closure after the tourniquet is deflated and during closure.
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1 vial (1g of IV tranexamic acid in 10mL solution) will be administered prior to inflation of the tourniquet.
A second 1g dose of IV tranexamic acid will be given during initiation of the closure after the tourniquet is deflated and during closure.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Total Blood Loss
Tidsramme: during surgery
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The amount of blood lost during surgery is the primary outcome measure.
Blood loss is determineusing an equation that calculates the patient's blood volume based on their height and weight, then multiplies the patient's blood volume by the change in their hematocrit after surgery compared to before surgery.
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during surgery
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Drain Output
Tidsramme: from end of surgery to 24 hours postoperatively
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The amount of blood collected by a drain attached to the knee is measured 24 hours after surgery.
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from end of surgery to 24 hours postoperatively
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The Number Patients Requiring a Transfusion
Tidsramme: over course of hospital stay (averaging three days)
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TThe number Patients requiring a transfusion over the course of the patient's hospital stay.
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over course of hospital stay (averaging three days)
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Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: David Mayman, MD, Hospital for Special Surgery, New York
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart (Faktiske)
1. maj 2013
Primær færdiggørelse (Faktiske)
28. december 2015
Studieafslutning (Faktiske)
16. maj 2017
Datoer for studieregistrering
Først indsendt
9. september 2013
Først indsendt, der opfyldte QC-kriterier
9. september 2013
Først opslået (Skøn)
12. september 2013
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
27. november 2019
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
8. november 2019
Sidst verificeret
1. november 2019
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 12166
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