The efficacy and safety of tranexamic acid in revision total knee arthroplasty: a meta-analysis

Abstract

BackgroundThere is no consistent conclusion regarding the efficacy and safety of the intravenous administration of tranexamic acid (TXA) for reducing blood loss in revision total knee arthroplasty (TKA). We performed a meta-analysis of comparative trials to evaluate the efficacy and safety of TXA in revision TKA.MethodsWe conducted a search of PubMed, EMBASE, The Cochrane Library and Web of Science for randomized controlled trials (RCTs) and non-RCTs. Two authors selected the studies, extracted the data, and assessed the risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software.ResultsFour non-RCTs met the inclusion criteria. The meta-analysis indicated that the use of TXA was related to significantly less transfusion requirements (RD = −0.25; 95% CI: -0.43 to −0.08; P = 0.005), drainage volume (MD = −321.07; 95% CI: -445.13 to −197.01, P = 0.005), hemoglobin reduction (MD = −0.52; 95% CI: -0.79 to −0.25, P = 0.0001), and length of hospital stay (MD = −2.36; 95% CI: -4.00 to −0.71, P = 0.005). No significant differences in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were noted.ConclusionsThe use of TXA for patients undergoing revision TKA may reduce blood loss and transfusion requirements without increasing the risk of postoperative venous thromboembolism. Due to the limited quality of the currently available evidence, more high-quality RCTs are required.

Prophylaktische Anwendung von Tranexamsäure in der nichtkardialen Chirurgie

“…Es fand sich ein reduzierter perioperativer Blutverlust (gewichtete mittlere Differenz [MD] -504,90 ml, 95 %-CI -620,89 bis -388,92 ml; p < 0,0001) sowie eine geringere Rate allogener Bluttransfusionen (MD -1,43; 95 %-CI -1,69 bis -1,17; p < 0,0001). Zwei aktuelle Metaanalysen bestätigen diesen Effekt für den simultanen bilateralen Kniegelenksersatz sowie bei Revisionsoperationen [72,82]. Anzumerken ist, dass in den meisten Studien TXA nicht zu Beginn der Operation, sondern erst kurz vor Öffnen der "Blutsperre" verabreicht wurde, um einer allfällig prothrombogenen Wirkung vorzubeugen.…”

A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty

“…The use of tranexamic acid decreases hematoma formation and blood loss. A recent meta-analysis reported that the use of tranexamic acid was related to a shorter length of hospital stay 9) . The use of a multimodal analgesic cocktail gives effective pain relief and functional recovery, which may also shorten the hospital stay 10) .…”

Cost Analysis in Knee Revision Arthroplasty: A Study at the Research and Training Hospital in Turkey

“…To reduce bleeding, techniques, such as skin heating, gentle soft tissue dissection during surgery, use of a new bipolar electrocautery device, use of cardiac stent, and if not contraindicated, discontinuation of anticoagulant drugs, and use of preoperative intra-and postoperative tranexamic acid drugs, can be applied (18,19).…”