Shangquan Wang1, Xinxia Gao1, Yan An2. 1. Department of Comprehensive Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Zhonghuan South Road, Beijing, 100102, China. 2. Department of Comprehensive Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Zhonghuan South Road, Beijing, 100102, China. anyanbj@163.com.
Abstract
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic drug used widely to prevent bleeding in total knee arthroplasty (TKA). However, there is no consensus regarding the administration routes of TXA. This meta-analysis aimed to investigate the efficacy of topical (intra-articular) versus intravenous TXA in reducing blood loss and transfusion rate in patients who underwent TKA. METHOD: We conducted a Pubmed, EMBASE, Cochrane Library, and Web of Science search for randomized controlled trials (RCTs) comparing topical versus intravenous TXA in TKA. Two authors conducted selection of studies, data extraction, and assessment of risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software. RESULT: Sixteen RCTs with a total of 1330 patients were included. Current meta-analysis indicated that there were no significant differences in total blood loss (MD = -41.64 ml; 95 % CI: -163.43 ml to 80.18 ml; P = 0.50), drain output (MD = 22.44, 95 % CI: -11.18 to 56.06, P = 0.19), transfusion rate (RR = 0.89, 95 % CI: 0.62 to 1.27, P = 0.52), the drop of Hb level at post-operative day 1 (MD = 0.26, 95 % CI -0.03 to 0.55, P = 0.03), day 2 (MD = -0.08, 95 % CI -0.76 to 0.59, P = 0.81), day 3 (MD = -0.20, 95 % CI -0.77 to 0.37, P = 0.49), and length of stay (MD = -0.10; 95 % CI: -0.17 to -0.02; P = 0.02) between the topical group and intravenous group. In addition, no significant differences were found regarding the incidence of adverse effects such as deep venous thrombosis (RR = 1.08, 95 % CI: 0.48 to 2.40, P = 0.86), pulmonary embolism (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), wound complications (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), and infection (RR = 0.74, 95 % CI: 0.30 to 1.85, P = 0.52) between the two groups. CONCLUSION: Our meta-analysis of 16 RCTs revealed that both topical TXA and intravenous TXA are effective in reducing blood loss and transfusion rates in patients who underwent TKA.
BACKGROUND:Tranexamic acid (TXA) is an antifibrinolytic drug used widely to prevent bleeding in total knee arthroplasty (TKA). However, there is no consensus regarding the administration routes of TXA. This meta-analysis aimed to investigate the efficacy of topical (intra-articular) versus intravenous TXA in reducing blood loss and transfusion rate in patients who underwent TKA. METHOD: We conducted a Pubmed, EMBASE, Cochrane Library, and Web of Science search for randomized controlled trials (RCTs) comparing topical versus intravenous TXA in TKA. Two authors conducted selection of studies, data extraction, and assessment of risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software. RESULT: Sixteen RCTs with a total of 1330 patients were included. Current meta-analysis indicated that there were no significant differences in total blood loss (MD = -41.64 ml; 95 % CI: -163.43 ml to 80.18 ml; P = 0.50), drain output (MD = 22.44, 95 % CI: -11.18 to 56.06, P = 0.19), transfusion rate (RR = 0.89, 95 % CI: 0.62 to 1.27, P = 0.52), the drop of Hb level at post-operative day 1 (MD = 0.26, 95 % CI -0.03 to 0.55, P = 0.03), day 2 (MD = -0.08, 95 % CI -0.76 to 0.59, P = 0.81), day 3 (MD = -0.20, 95 % CI -0.77 to 0.37, P = 0.49), and length of stay (MD = -0.10; 95 % CI: -0.17 to -0.02; P = 0.02) between the topical group and intravenous group. In addition, no significant differences were found regarding the incidence of adverse effects such as deep venous thrombosis (RR = 1.08, 95 % CI: 0.48 to 2.40, P = 0.86), pulmonary embolism (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), wound complications (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), and infection (RR = 0.74, 95 % CI: 0.30 to 1.85, P = 0.52) between the two groups. CONCLUSION: Our meta-analysis of 16 RCTs revealed that both topical TXA and intravenous TXA are effective in reducing blood loss and transfusion rates in patients who underwent TKA.
Entities:
Keywords:
Intravenous; Topical; Total knee arthroplasty; Tranexamic acid
Authors: Jay N Patel; Jonathon M Spanyer; Langan S Smith; Jiapeng Huang; Madhusudhan R Yakkanti; Arthur L Malkani Journal: J Arthroplasty Date: 2014-03-21 Impact factor: 4.757
Authors: X Aguilera; M J Martínez-Zapata; P Hinarejos; M Jordán; J Leal; J C González; J C Monllau; F Celaya; A Rodríguez-Arias; J A Fernández; X Pelfort; L l Puig-Verdie Journal: Arch Orthop Trauma Surg Date: 2015-05-07 Impact factor: 3.067
Authors: Jedediah H May; Geoffrey R Rieser; Chad G Williams; Ronald J Markert; Ryan D Bauman; Matthew W Lawless Journal: J Arthroplasty Date: 2016-04-30 Impact factor: 4.757
Authors: Michael E Stokes; Xin Ye; Manan Shah; Katie Mercaldi; Matthew W Reynolds; Marcia F T Rupnow; Jeffrey Hammond Journal: BMC Health Serv Res Date: 2011-05-31 Impact factor: 2.655