Comparison between peri-articular injection and intra-articular injection of tranexamic acid during total knee arthroplasty: A meta-analysis

Abstract

Total knee arthroplasty (TKA) has been proven to be a successful surgical procedure to correct deformity, relieve pain, and restore knee function. However, about 10 to 38% of patients following TKA require blood transfusion ranging between 1,000 mL and 2,000 mL for massive postoperative blood loss. [1,2] Blood transfusion may lead to transfusion-related complications and increase the medical burden. [3,4] Tranexamic acid (TXA), a synthetic lysine analogue, can competitively inhibit the activation of plasmin binding protein and plasminogen has been commonly utilized to reduce blood loss during TKA. [5,6] Multiple studies have reported that the intravenous (IV), Objectives: In this meta-analysis, we aimed to compare the efficacy and safety of peri-articular injection (PAI) and intraarticular injection (IAI) of tranexamic acid (TXA) in total knee arthroplasty (TKA). Patients and methods:We performed a comprehensive literature search from electronic databases such as Springer, Web of Science, PubMed, Cochrane Library databases, and ScienceDirect up to October 2021. The language of identified articles was not restricted. The keywords used for the search strategy included: "tranexamic acid", "total knee arthroplasty", "peri-articular injection" and "intra-articular injection".Results: Two randomized-controlled trials (RCTs) and four non-RCTs with a total of 491 patients met the inclusion criteria. Of the patients, 242 patients were in the PAI group and 249 patients were in the IAI group. No significant difference was observed between the two groups in hemoglobin drop, postoperative drainage volume, total blood loss, blood transfusion requirements, or units of blood transfused. There was no significant difference between the two groups regarding postoperative infection or deep venous thrombosis. Conclusion:The PAI of TXA is comparable to IAI of TXA in decreasing postoperative blood loss during TKA.

Optimised fast‐track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications

“…Preoperative anaemia assessment, targeted blood conservation techniques and appropriate transfusion thresholds are all part of these strategies. By implementing these evidence-based recommendations, clinical settings have observed reduced transfusion rates and enhanced patient recovery [22,24,27].…”

Optimizando la artroplastia total de rodilla: el impacto del ácido tranexámico

“…Además, hasta un cuarto de los pacientes podrían requerir una transfusión sanguínea debido a una anemia postoperatoria. [7][8][9] La hemorragia se ha asociado a la formación de hematomas y un posible drenaje prolongado, esta puede demorar la recuperación, lo que incrementa los gastos de atención médica. 10 Además, al término de la ATR, al retiro del torniquete, se produce un incremento en la actividad fibrinolítica, lo que a su vez provoca un aumento notorio en el sangrado.…”

“…11,12 Por lo cual, son necesarias estrategias para reducir la probabilidad de hemorragia. 7,8,13,14 La conducta recomendada es la evaluación personalizada del riesgo de sangrado para así emplear la mejor táctica. 14 Se han empleado diversas estrategias, por mencionar, el uso de aerosoles de fibrina y hemostáticos, 15 el uso de antifibrinolíticos se ha destacado como un plan económico y seguro; recientemente, el uso de ácido tranexámico (ATX) ha sido ampliamente utilizado en el área quirúrgica con resultados satisfactorios en relación con la reducción de la mortalidad por hemorragia y a la necesidad de transfusión sanguínea.…”

Comparison of efficacy between tranexamic acid and epsilon-aminocaproic acid for total knee arthroplasty: A meta-analysis of randomized controlled trials

“…[3] Previous articles have reflected that there was an estimated 750 to 1800 mL of calculated total blood loss (TBL) during TKA. [4,5] As a result of massive bleeding in the knee cavity and soft tissue space, patients will experience further swelling and pain, which may adversely affect their willingness to exercise after surgery, as well as their overall satisfaction. [6] Moreover, blood loss may require a large amount of blood transfusion.…”