Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis

Abstract

BackgroundTranexamic acid (TXA) is an antifibrinolytic drug used as a blood-sparing technique in many surgical specialties. The principal objective of our meta-analysis was to review randomized, controlled trials (RCT) comparing total blood loss and the number of patients receiving allogeneic blood transfusions with and without the use of TXA for knee (TKA) and hip (THA) arthroplasty.MethodsStudies were included if patients underwent primary unilateral TKA or THA; the study involved the comparison of a TXA treatment group to a control group who received either a placebo or no treatment at all; outcome measures included total blood loss TBL, number of patients receiving allogeneic blood transfusions, and/or incidence of thromboembolic complications; the study was a published or unpublished RCT from 1995 – July 2012.ResultsData were tested for publication bias and statistical heterogeneity. Combined weighted mean differences in blood loss favoured TXA over control for TKA and THA patients respectively [ −1.149 (p < 0.001; 95% CI −1.298, -1.000), -0.504 (p < 0.001; 95% CI, -0.672, -0.336)]. Combined odds ratios favoured fewer patients requiring allogeneic transfusions for TKA and THA with the use of TXA respectively [0.145 (p < 0.001; 95% CI, 0.094, 0.223), 0.327 (p < 0.001; 95% CI, 0.208, 0.515)]. Combined odds ratios indicated no increased incidence of DVT with TXA use in TKA and THA respectively [1.030 (p = 0.946; 95% CI, 0.439, 2.420), 1.070 (p = 0.895; 95% CI, 0.393, 2.911)].ConclusionsTXA should be considered for routine use in primary knee and hip arthroplasty to decrease blood loss.

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

“…Among those strategies, TXA administration has proved to effectively decrease transfusion rates, particularly in meta-analyses of trials [7][8][9] and with repeated dose [10]. Interest remains in clarifying how blood transfusion can even be effectively avoided after TKA.…”

Clinical and Financial Benefits of Intra-Articular Tranexamic Acid in Total Knee Arthroplasty

“…14 TXA use decreases blood loss and necessitates fewer blood transfusions. 15 TXA reduces blood loss by 29% and reduces the risk of receiving a blood transfusion by 45%. 16 Intra-articular TXA reduces blood loss and knee joint swelling.…”

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

“…Méthode Nous avons mis en oeuvre une politique de qualité des soins afin de procéder à l'administration universelle de TXA par voie intraveineuse à une dose de 20 mgÁkg -1 à tous les patients admissibles subissant une arthroplastie totale de la hanche ou du genou entre le 21 Administration of tranexamic acid (TXA) has been shown to reduce blood loss and allogeneic red blood cell (RBC) transfusion in cardiac and various noncardiac surgical procedures. 1 Many randomized controlled trials, [2][3][4][5][6] systematic reviews, and meta-analyses [7][8][9][10][11] have shown that systemic and topically administered TXA reduces allogeneic RBC transfusion in hip or knee arthroplasty surgery. Recent observational studies have also shown an association between TXA use and reduced RBC transfusion.…”