Efficiency and Safety of Intravenous Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

Abstract

The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of i.v. tranexamic acid (TXA) in simultaneous bilateral total knee arthroplasty (TKA). Potentially relevant published reports were identified from the following electronic databases: Medline, PubMed, Embase, ScienceDirect and Cochrane Library. RevMan v5.3was used to pool data. Two randomized controlled trials and four case-control studies met the inclusion criteria. The current meta-analysis identified significant differences between TXA group and control groups in terms of postoperative hemoglobin concentration (P < 0.01), drainage volume (P < 0.01), transfusion rate (P < 0.01) and units transfused (P = 0.006). There were no significant differences in length of stay (P = 0.66), operation time (P = 0.81) or and incidence of adverse effects such as infection (P = 0.42), deep venous thrombosis (DVT) (P = 0.88) and pulmonary embolism (PE) (P = 0.11). Our results show that i.v. administration of TXA in simultaneous bilateral TKA reduces postoperative drops in hemoglobin concentration, drainage volume, and transfusion requirements and does not prolong length of stay or operation time. Moreover, no adverse effects, such as infection, DVT or PE, were associated with TXA.

Effectiveness and safety of an optimized blood management program in total hip and knee arthroplasty

“…As an analogue of the amino acid lysine, tranexamic acid (TXA) can competitively inhibit plasminogen activation and plasmin binding to fibrin to achieve the effect of anti-fibrinolysis, [ 14 ] and thus reduce perioperative blood loss and transfusion rate. [ 9 , 15 ] There are 3 common methods of TXA administration in THA and TKA patients: intravenous, [ 16 ] topical, [ 17 ] and combined application. [ 6 ] Many studies have shown that combined application is the most effective regimen.…”

Identifying the period of greatest blood loss after lower limb arthroplasty

“…Tranexamic acid (TXA) effectively decreases perioperative blood loss via intravenous [8], oral [9], and topical [10] routes and appears to be safe [11], [12]. One of the earliest randomized studies demonstrating the efficacy of TXA in reducing blood loss after total joint arthroplasty was published in 1997 [13], and it has since been adopted in many medical and surgical specialties [14].…”

Intravenous Combined with Topical Administration of Tranexamic Acid in Primary Total Hip Arthroplasty: A Randomized Controlled Trial

“…It is estimated that one‐third of patients who received THA required transfusion of one to three units of blood, and the reported range of transfusion rates are between 25% and 84%. The risks of blood transfusion include immunological reactions, volume overload, infection, intravascular hemolysis, renal failure, and even death. Therefore, determining how to reduce bleeding and, therefore, transfusions following THA has become an important and urgent problem to be resolved for orthopedist.…”