Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials

Wu, Qiang; Zhang, Hongan; Liu, Shi-Long; Tao, Meng; Zhou, Xin; Wang, Ping

doi:10.1007/s00590-014-1568-z

Cited by 73 publications

(67 citation statements)

References 46 publications

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“…The main findings of this metaanalysis have been confirmed in other meta-analyses that included additional trials for TKA, THA, and spine surgery, but several important questions remain unanswered [3,14,15]. For example, additional large observational studies are warranted to resolve uncertainty in the risks for thromboembolic harms, clarify whether certain dosing regimens might be superior to others, investigate use in specific patient populations such as those with contraindications to intravenous tranexamic acid, and investigate efficacy and cost-effectiveness in combination with other perioperative blood management strategies.…”

Section: Take-home Messagessupporting

confidence: 63%

Cochrane in CORR ®: Topical Application of Tranexamic Acid for the Reduction of Bleeding (Review)

Evaniew

Bhandari

2017

Clinical Orthopaedics &Amp; Related Research

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Section: Take-home Messagessupporting

confidence: 63%

Cochrane in CORR ®: Topical Application of Tranexamic Acid for the Reduction of Bleeding (Review)

Evaniew

Bhandari

2017

Clinical Orthopaedics &Amp; Related Research

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“…The use of TXA in primary TKA is today widely accepted, and several studies and meta-analyses have confirmed the efficacy of TXA at decreasing blood loss without increasing complications and costs [9, 13, 14]. Several clinical trials have identified that intravenous (IV) TXA is effective in reducing perioperative blood loss and the need for subsequent blood transfusions in TKA [15–17].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Chen

Jiao

et al. 2017

J Orthop Surg Res

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BackgroundThis study aims to compare the effectiveness and safety of topical versus intravenous tranexamic acid (TXA) in reducing blood loss in primary total knee arthroplasty (TKA).MethodsPubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedicine Literature (CBM), Wanfang Database and China National Knowledge Infrastructure (CNKI), and Google Scholar were searched for randomized controlled studies (RCTs) that compared topical versus intravenous TXA in terms of reducing blood loss during TKA from their inception to September 2015. This systematic review and meta-analysis was performed according to PRISMA criteria.ResultsTwelve studies reporting 12 RCTs comprising 1130 patients were included. Compared with the intravenous administration of TXA, the topical administration of TXA showed no significant differences in total blood loss (MD 2.08, 95% CI −68.43 to 72.60, P = 0.95), blood loss in drainage (MD 18.49, 95% CI −40.01 to 76.98, P = 0.54), hidden blood loss (MD 4.75, 95% CI −337.94 to 347.44, P = 0.99), need for transfusion (RR = 0.92, 95% CI 0.67~1.25, P = 0.58), hemoglobin (Hb) decline (MD −0.42, 95% CI −0.89 to 0.05, P = 0.08), and DVT occurrence (RR = 1.17, 95% CI 0.55~2.50, P = 0.68).ConclusionsCompared with intravenous administration TXA, topical administration TXA exhibits comparable effectiveness and safety in terms of reducing blood loss during TKA. Due to the poor quality of the included studies, more high-quality RCTs are needed to identify the optimal method and dose of TXA after TKA.

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“…The effect of TXA in reducing postoperative bleeding has been well established in many previous studies, primarily focused on total joint arthroplasty and spine surgery. [11][12][13][14][15][16][17][18][19] The reduced bleeding potentially allows for faster recovery and better early clinical outcomes. One study reported that TXA improves early functional outcomes of primary total knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Tranexamic Acid for Hemostasis in Patients Undergoing High Tibial Osteotomy

et al. 2017

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Extensive bone bleeding and an uncomfortable hematoma can develop due to the opening gap and space during a medial open high tibial osteotomy (HTO). Tranexamic acid (TXA) has been used in various orthopaedic surgeries to reduce bleeding and wound complications. However, no study has investigated the effect of TXA during HTO. Therefore, the purpose of this study is to evaluate the efficacy of TXA in reducing postoperative blood loss in patients undergoing HTO. The hypothesis is that topical TXA administration will reduce postoperative bleeding in patients undergoing medial opening HTO. Topical TXA (2 g in 20 mL saline) was administered at the osteotomy site in patients ( = 15) who underwent medial open HTO from November 2015 to March 2016. Patients ( = 15) who underwent medial open wedge HTO by the same surgeon from October 2014 to October 2015 were enrolled as a control group for comparison. Drainage volumes on postoperative days (PODs) 1, 2, and 3 as well as hemoglobin (Hb) level on PODs 1, 6, and 13 were measured and compared. Mean total postoperative drainage volume was 246 mL in the TXA group and 377 mL in the control group. Mean drainage volume on POD 1 was 138 mL in the TXA group and 277 mL in the control group ( < 0.05). No differences in drainage volume were detected between the groups on POD 2 or 3. Preoperative Hb levels were 13.0 g/dL in the TXA group and 12.9 g/dL in the control group, which decreased to 11.9 g/dL in the TXA group and 11.2 g/dL in the control group on POD 1. These postoperative Hb differences were significant ( < 0.05). Also, Hb levels were 11.7 and 12.0 g/dL in the TXA group and 11.4 and 11.6 g/dL in the control group on PODs 6 and 13, respectively ( > 0.05). An extensive hematoma requiring additional surgery developed in one case in the control group. No wound complications were detected in the TXA group. Topical TXA was effective for reducing postoperative bleeding after medial open HTO. The level of evidence of the study is Level 3.

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Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials

Abstract: Level II.

Cited by 73 publications

References 46 publications

Cochrane in CORR ®: Topical Application of Tranexamic Acid for the Reduction of Bleeding (Review)

Cochrane in CORR ®: Topical Application of Tranexamic Acid for the Reduction of Bleeding (Review)

Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Efficacy of Tranexamic Acid for Hemostasis in Patients Undergoing High Tibial Osteotomy

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