Randomized Controlled Trial of Tranexamic Acid in Total Knee Arthroplasty: Intravenous vs. Topical
8. november 2019 oppdatert av: 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.
Studieoversikt
Status
Fullført
Forhold
Intervensjon / Behandling
Detaljert 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.
Studietype
Intervensjonell
Registrering (Faktiske)
640
Fase
- Fase 4
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiesteder
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Minnesota
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Rochester, Minnesota, Forente stater, 55902
- Mayo Clinic
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New York
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New York, New York, Forente stater, 10021
- Hospital for Special Surgery
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Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
18 år til 100 år (Voksen, Eldre voksen)
Tar imot friske frivillige
Nei
Kjønn som er kvalifisert for studier
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
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Trippel
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / 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.
|
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.
|
|
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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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
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 |
Tiltaksbeskrivelse |
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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Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: David Mayman, MD, Hospital for Special Surgery, New York
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart (Faktiske)
1. mai 2013
Primær fullføring (Faktiske)
28. desember 2015
Studiet fullført (Faktiske)
16. mai 2017
Datoer for studieregistrering
Først innsendt
9. september 2013
Først innsendt som oppfylte QC-kriteriene
9. september 2013
Først lagt ut (Anslag)
12. september 2013
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
27. november 2019
Siste oppdatering sendt inn som oppfylte QC-kriteriene
8. november 2019
Sist bekreftet
1. november 2019
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- 12166
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