Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

Li, Jin; Liu, Ruikang; Rai, Saroj; Ze, Renhao; Tang, Xin; Hong, Pan

doi:10.1186/s13018-020-02119-1

Cited by 16 publications

(20 citation statements)

References 59 publications

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“…Li et al reported that the intravenous tranexamic acid group showed a greater postoperative hemoglobin drop than the IA group. 25 Similarly, in the current study, the mean variation of Hct in the intraarticular group was 4.49 and 6.82 in the intra-venous tranexamic acid group (p = 0.001). In contrast to the above studies, in a review of six randomized controlled and meta-analysis studies in total knee replacements compared results in terms of intraoperative blood losses and number of blood transfusions, the authors did not find any difference between blood transfusions and thromboembolic complications to compare results of intraarticular and intravenous tranexamic acid.…”

Section: Discussionsupporting

confidence: 74%

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Naqshaband¹,

Taqi²,

Ashraf³

et al. 2021

J Fatima Jinnah Med Univ

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Background: The goal of this research was to assess the effectiveness and safety of intra-articular tranexamic acid (TA) with intravenous (IV) TA in reducing perioperative blood loss, the severity of early postoperative problems, and venous thromboembolism in patients who have had a primary unilateral cemented total knee replacement. Patients and methods: This comparative study was undertaken using a non-probability purposive sampling technique at the Department of Orthopedic Surgery, King Edward Medical University / Mayo Hospital, Lahore, from July 1st, 2018 to October 30th, 2019. A total of number 71 patients, aged 35 to 75 years, who underwent unilateral cemented total knee replacement for advanced knee osteoarthritis were included in the study. Patients who had known allergic reactions to tranexamic acid, risk factors of thromboembolism, severe kidney and heart diseases, and blood clotting disorders were excluded. The patients were divided into two groups, A and B. Pre-operatively, patients in Group A were given intraarticular tranexamic acid (3000mg). In Group B, intravenous tranexamic acid (10mg/kg) was given pre-operatively. Outcome parameters studied were drained blood (DB), level of hemoglobin (Hb), blood transfusion (BT), and hematocrit (Hct) after 48 hours of surgery and compared with the preoperative value. Data was entered and analyzed using SPSS version 21.0. Independent sample T-test was applied to compare the hematocrit and hemoglobin difference in the two groups, and the P-value was taken less than 0.05 as significant. Results: Out of the total 36 patients in Group A, there were 20 (55.5%) males and 16 (44.4%) females, while amongst 35 patients in Group B, there were 21 (60%) males and 14 (40%) females. The mean preoperative Haemoglobin (Hb) in Group A was 13.9+1.2 and 13.8+0.9 in Group B (p = 0.44). The mean postoperative Hb in Group A was 12.11±2.47 and 11.24 ± 3.52 in Group B (p = 0.002). The mean variation of Hct in Group A was 4.49 and 6.82 in Group B (p = 0.001). Conclusion: Intra-articular tranexamic acid during total knee joint replacement is a viable alternative to the established intravenous tranexamic acid with statistically significant high postoperative hemoglobin and hematocrit levels.

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Section: Discussionsupporting

confidence: 74%

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Naqshaband¹,

Taqi²,

Ashraf³

et al. 2021

J Fatima Jinnah Med Univ

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“…Li’s research suggested topical usage: topical TXA reduced 33.38 ml more than IV TXA did on total blood loss (WMD 33.38, 95% CI, 19.24–47.51). However, Li et al (2020) demonstrated insignificant differences in the blood transfusion rate and adverse effects. In addition, similar outcomes were found in oral and IV TXA for all aspects.…”

Section: Discussionmentioning

confidence: 88%

“…In terms of dosage, Chen et al suggested that a high dose of IV TXA (30 mg/kg) was more effective than a low dose (15–20 mg/kg) in reducing blood loss without increasing the risk of DVT ( Chen et al, 2014 ). However, the heterogeneity may come from selection biases: Sukeik et al (2020) , Chen et al, and Wu et al (2017) mentioned that patients with a cardiovascular disease history and renal insufficiency were excluded, but Guo et al, Kirsch et al (2017) , and Li et al (2020) did not. As for administration routes, detailed outcomes are displayed in Supplementary Appendix S15 .…”

Section: Discussionmentioning

confidence: 99%

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

et al. 2022

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Background: Tranexamic acid (TXA) has been applied in various types of surgery for hemostasis purposes. The efficacy and safety of TXA are still controversial in different surgeries. Guidelines for clinical application of TXA are needed.Materials and method: We systematically searched multiple medical databases for meta-analyses examining the efficacy and safety of TXA. Types of surgery included joint replacement surgery, other orthopedic surgeries, cardiac surgery, cerebral surgery, etc. Outcomes were blood loss, blood transfusion, adverse events, re-operation rate, operative time and length of hospital stay, hemoglobin (Hb) level, and coagulation function. Assessing the methodological quality of systematic reviews 2 (AMSTAR 2) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) were used for quality assessment of the included meta-analyses. Overlapping reviews were evaluated by calculating the corrected covered area (CCA).Result: In all, we identified 47 meta-analyses, of which 44 of them were of “high” quality. A total of 319 outcomes were evaluated, in which 58 outcomes were assessed as “high” quality. TXA demonstrates significant hemostatic effects in various surgeries, with lower rates of blood transfusion and re-operation, shorter operative time and length of stay, and higher Hb levels. Besides, TXA does not increase the risk of death and vascular adverse events, but it is a risk factor for seizure (a neurological event) in cardiac surgery.Conclusion: Our study demonstrates that TXA has a general hemostatic effect with very few adverse events, which indicates TXA is the recommended medication to prevent excessive bleeding and reduce the blood transfusion rate. We also recommend different dosages of TXA for different types of adult surgery. However, we could not recommend a unified dosage for different surgeries due to the heterogeneity of the experimental design.Systematic Review Registration:clinicaltrials.gov/, identifier CRD42021240303

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“…In contrast, the most updated systematic review and meta-analysis by Li and colleagues comparing intravenous versus intra-articular TXA in total knee replacement surgery reported greater reduction of intraoperative blood loss and incidence of blood transfusion in those who received intra-articular TXA. 39 Thus, future adequately powered RCTs are warranted to fill knowledge gap with regard to the efficacy and safety of different route of TXA administration in arthroscopic ACLR surgery. Of note, the threshold of blood transfusion varies from one study to another, which may potentially introduce variances to the finding.…”

Section: Discussionmentioning

confidence: 99%

Effect of tranexamic acid in arthroscopic anterior cruciate ligament repair: A systematic review and meta-analysis of randomised clinical trials

Tan

Lim

et al. 2021

J Orthop Surg (Hong Kong)

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Purpose: Perioperative blood loss remains a major challenge to surgeons in anterior cruciate ligament reconstruction (ACLR) surgery, despite of the introduction of minimally invasive approach. Tranexamic acid (TXA) is believed to reduce blood loss, which may minimise the complication of postoperative haemarthrosis with insufficient evidence on its effectiveness in ACLR. The primary aim of this study was to examine the effect of TXA on postoperative blood loss and other secondary outcomes in patients undergoing arthroscopic ACLR surgery. Method: PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched from its inception until November 2020. All randomised clinical trials (RCTs) comparing TXA (intravenous or intra-articular) versus placebo in the arthroscopic ACLR surgery were included. Case series, case report and editorials were excluded. Results: Five RCTs comprising of a total of 580 patients (291 in TXA group, 289 in control group) were included for qualitative and quantitative meta-analysis. In comparison to placebo, TXA group was significantly associated with lower postoperative blood loss (mean difference (MD): −81.93 ml; 95% CI −141.80 to −22.05) and lower incidence of needing knee aspiration (odd ratio (OR): 0.19; 95% CI 0.08 to 0.44). Patients who randomised to TXA were also reported to have better range of movement (MD: 2.86; 95% CI 0.54 to 5.18), lower VAS Pain Score (MD: −1.39; 95% CI −2.54 to −0.25) and higher Lysholm Score (MD: 7.38; 95% CI 2.75 to 12.01). Conclusion: In this meta-analysis, TXA reduced postoperative blood loss with lesser incidence of needing knee aspiration along with better range of knee movement and Lysholm score in patients undergoing arthroscopic ACLR surgery.

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Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

Cited by 16 publications

References 59 publications

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

Effect of tranexamic acid in arthroscopic anterior cruciate ligament repair: A systematic review and meta-analysis of randomised clinical trials

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