The Efficacy of Tranexamic Acid in Total Hip Arthroplasty: A Network Meta-analysis

Fillingham, Yale A.; Ramkumar, Dipak B.; Jevsevar, David S.; Yates, Adolph J.; Shores, Peter; Mullen, Kyle; Bini, Stefano A.; Clarke, Henry D.; Schemitsch, Emil H.; Johnson, Rebecca L.; Memtsoudis, Stavros G.; Sayeed, Siraj A.; Sah, Alexander P.; Valle, Craig J. Della

doi:10.1016/j.arth.2018.06.023

Cited by 154 publications

(182 citation statements)

References 40 publications

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“…Similarly, intravenous and topical TXA were found to reduce the risk of transfusion compared with placebo by 60% and 71%, respectively 2. Network meta-analysis of low-dose intravenous (<20 mg/kg or ≤1 g), high-dose intravenous (≥20 mg/kg or >1 g), high-dose topical (>1.5 g), oral and combined intravenous/topical TXA reduced the risk for blood loss compared with placebo 2. Correspondingly, network meta-analysis demonstrated low-dose intravenous, high-dose intravenous, high-dose topical, low-dose topical and combined intravenous/topical TXA to significantly reduce the risk of transfusion 2…”

Section: Guideline Questionmentioning

confidence: 95%

“…The direct meta-analysis of one moderate-quality and 82 high-quality studies provided significant evidence for the ability of TXA to reduce the risk of blood loss and need for transfusion during the perioperative episode of primary hip and knee arthroplasties 2. Subsequent network meta-analysis supported the blood-sparing properties of TXA 2…”

Section: Guideline Questionmentioning

confidence: 98%

“…Intravenous and topical TXA have been shown with limited heterogeneity in direct meta-analysis to reduce blood loss 2. Similarly, intravenous and topical TXA were found to reduce the risk of transfusion compared with placebo by 60% and 71%, respectively 2.…”

Section: Guideline Questionmentioning

confidence: 99%

Section: Guideline Questionmentioning

confidence: 99%

“…Due to a lack of studies directly comparing oral TXA with placebo, no conclusions could be derived in the direct meta-analysis 2. Network meta-analysis was performed to provide an indirect comparison of oral TXA, which demonstrated significantly reduced blood loss compared with placebo 2.…”

Section: Guideline Questionmentioning

confidence: 99%

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Tranexamic acid in total joint arthroplasty: the endorsed clinical practice guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

Fillingham

Ramkumar

Jevsevar

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

Self Cite

106

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Section: Guideline Questionmentioning

confidence: 95%

Section: Guideline Questionmentioning

confidence: 98%

Section: Guideline Questionmentioning

confidence: 99%

Section: Guideline Questionmentioning

confidence: 99%

Section: Guideline Questionmentioning

confidence: 99%

See 3 more Smart Citations

Tranexamic acid in total joint arthroplasty: the endorsed clinical practice guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

Fillingham

Ramkumar

Jevsevar

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

Self Cite

106

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Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Gibbs,

Champaneria,

Sandercock

et al. 2024

Cochrane Database of Systematic Reviews

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Background Hip and knee replacement surgery is a well‐established means of improving quality of life, but is associated with a significant risk of bleeding. One‐third of people are estimated to be anaemic before hip or knee replacement surgery; coupled with the blood lost during surgery, up to 90% of individuals are anaemic postoperatively. As a result, people undergoing orthopaedic surgery receive 3.9% of all packed red blood cell transfusions in the UK. Bleeding and the need for allogeneic blood transfusions has been shown to increase the risk of surgical site infection and mortality, and is associated with an increased duration of hospital stay and costs associated with surgery. Reducing blood loss during surgery may reduce the risk of allogeneic blood transfusion, reduce costs and improve outcomes following surgery. Several pharmacological interventions are available and currently employed as part of routine clinical care. Objectives To determine the relative efficacy of pharmacological interventions for preventing blood loss in elective primary or revision hip or knee replacement, and to identify optimal administration of interventions regarding timing, dose and route, using network meta‐analysis (NMA) methodology. Search methods We searched the following databases for randomised controlled trials (RCTs) and systematic reviews, from inception to 18 October 2022: CENTRAL (the Cochrane Library), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO host ), Transfusion Evidence Library (Evidentia), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). Selection criteria We included RCTs of people undergoing elective hip or knee surgery only. We excluded non‐elective or emergency procedures, and studies published since 2010 that had not been prospectively registered (Cochrane Injuries policy). There were no restrictions on gender, ethnicity or age (adults only). We excluded studies that used standard of care as the comparator. Eligible interventions included: antifibrinolytics (tranexamic acid (TXA), aprotinin, epsilon‐aminocaproic acid (EACA)), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants and non‐fibrin sealants. Data collection and analysis We performed the review according to standard Cochrane methodology. Two authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using CINeMA. We presented direct (pairwise) results using RevMan Web and performed the NMA using BUGSnet. We were interested in the following primary outcomes: need for allogenic blood transfusion (up to 30 days) and all‐cause mortality (deaths occurring up to 30 days after the operation), and the following secondary outcomes: mean number of transfusion episodes per person (up to 30 days), re‐operation due to...

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Blood Transfusion

Ekhtiari

Sanders

Carson

2021

Evidence‐Based Orthopedics

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The Efficacy of Tranexamic Acid in Total Hip Arthroplasty: A Network Meta-analysis

Cited by 154 publications

References 40 publications

Tranexamic acid in total joint arthroplasty: the endorsed clinical practice guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

Tranexamic acid in total joint arthroplasty: the endorsed clinical practice guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Blood Transfusion

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