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

• Published in: European journal of orthopaedic surgery & traumatology Vol. 25; no. 3; pp. 525 - 541
• Main Authors: Wu, Qiang, Zhang, Hong-An, Liu, Shi-Long, Meng, Tao, Zhou, Xin, Wang, Ping
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.04.2015; Springer Nature B.V
• Subjects: Administration, Intravenous; Antifibrinolytic Agents - administration & dosage; Antifibrinolytic Agents - adverse effects; Arthroplasty, Replacement, Knee - methods; Blood Loss, Surgical - prevention & control; Blood Transfusion; Clinical trials; Hemoglobins - metabolism; Humans; Injections, Intra-Articular; Joint replacement surgery; Medicine; Medicine & Public Health; Meta-analysis; Original Article; Postoperative Hemorrhage - prevention & control; Randomized Controlled Trials as Topic; Sharks; Surgical Orthopedics; Tranexamic Acid - administration & dosage; Tranexamic Acid - adverse effects; Traumatic Surgery; Tranexamic acid; Transfusion; TKA; Blood loss; Meta-analysis
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-014-1568-z

Background Tranexamic acid (TXA) is well established as a versatile intraarticular and intravenous (IV) antifibrinolytic agent that has been successfully used to control bleeding after total knee arthroplasty (TKA). The present meta-analysis aimed at assessing the effectiveness and safety of TXA in reducing blood loss and transfusion in TKA. Methods We searched the PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases from 1966 to December 2013. Only randomized controlled trials (RCTs) were included in the present study. Two independent reviewers identified the eligible studies, assessed their methodological quality, and extracted data. The data were using fixed-effects or random-effects models with standard mean differences and risk ratios for continuous and dichotomous variables, respectively. Subgroup analysis was performed according to the IV or intraarticular administration of TXA. Results Thirty-four RCTs encompassing 2,594 patients met the inclusion criteria for our meta-analysis. Our meta-analysis indicated that when compared with the control group, the IV or intraarticular use of TXA significantly reduced total blood loss, postoperative blood loss, Hb loss, and transfusion rate as well as blood units transfused per patient after primary TKA, but did not reduce intraoperative blood loss. No significant difference in deep vein thrombosis (DVT), pulmonary embolism, or other adverse events among the study groups. Conclusions IV or intraarticular use of TXA for patients undergoing TKA is effective and safe for the reduction blood loss and blood transfusion requirements, yet does not increase the risk of postoperative DVT. Level of evidence Level II.