Yale A Fillingham1, Dipak B Ramkumar2, David S Jevsevar2, Adolph J Yates3, Peter Shores4, Kyle Mullen4, Stefano A Bini5, Henry D Clarke6, Emil Schemitsch7, Rebecca L Johnson8, Stavros G Memtsoudis9, Siraj A Sayeed10, Alexander P Sah11, Craig J Della Valle1. 1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois. 2. Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. 3. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 4. Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, Illinois. 5. Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California. 6. Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona. 7. Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada. 8. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota. 9. Department of Anesthesiology, Hospital for Special Surgery, New York, New York. 10. South Texas Bone and Joint Institute, San Antonio, Texas. 11. Institute for Joint Restoration, Fremont, California.
Abstract
BACKGROUND: A growing body of published research on tranexamic acid (TXA) suggests that it is effective in reducing blood loss and the risk for transfusion in total knee arthroplasty (TKA). The purpose of this network meta-analysis was to evaluate TXA in primary TKA as the basis for the efficacy recommendations of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine on the use of TXA in primary total joint arthroplasty. METHODS: We searched Ovid MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases for publications before July 2017 on TXA in primary total joint arthroplasty. All included studies underwent qualitative and quantitative homogeneity testing. Direct and indirect comparisons were performed as a network meta-analysis, and results were tested for consistency. RESULTS: After critical appraisal of the available 2113 publications, 67 articles were identified as representing the best available evidence. Topical, intravenous (IV), and oral TXA formulations were all superior to placebo in terms of decreasing blood loss and risk of transfusion, while no formulation was clearly superior. Use of repeat IV and oral TXA dosing and higher doses of IV and topical TXA did not significantly reduce blood loss or risk of transfusion. Preincision administration of IV TXA had inconsistent findings with a reduced risk of transfusion but no effect on volume of blood loss. CONCLUSIONS: Strong evidence supports the efficacy of TXA to decrease blood loss and the risk of transfusion after primary TKA. No TXA formulation, dosage, or number of doses provided clearly improved blood-sparing properties for TKA. Moderate evidence supports preincision administration of IV TXA to improve efficacy.
BACKGROUND: A growing body of published research on tranexamic acid (TXA) suggests that it is effective in reducing blood loss and the risk for transfusion in total knee arthroplasty (TKA). The purpose of this network meta-analysis was to evaluate TXA in primary TKA as the basis for the efficacy recommendations of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine on the use of TXA in primary total joint arthroplasty. METHODS: We searched Ovid MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases for publications before July 2017 on TXA in primary total joint arthroplasty. All included studies underwent qualitative and quantitative homogeneity testing. Direct and indirect comparisons were performed as a network meta-analysis, and results were tested for consistency. RESULTS: After critical appraisal of the available 2113 publications, 67 articles were identified as representing the best available evidence. Topical, intravenous (IV), and oral TXA formulations were all superior to placebo in terms of decreasing blood loss and risk of transfusion, while no formulation was clearly superior. Use of repeat IV and oral TXA dosing and higher doses of IV and topical TXA did not significantly reduce blood loss or risk of transfusion. Preincision administration of IV TXA had inconsistent findings with a reduced risk of transfusion but no effect on volume of blood loss. CONCLUSIONS: Strong evidence supports the efficacy of TXA to decrease blood loss and the risk of transfusion after primary TKA. No TXA formulation, dosage, or number of doses provided clearly improved blood-sparing properties for TKA. Moderate evidence supports preincision administration of IV TXA to improve efficacy.
Authors: Ioannis Gkiatas; Aristeidis-Panagiotis Kontokostopoulos; Spyridon E Tsirigkakis; Ioannis Kostas-Agnantis; Ioannis Gelalis; Anastasios Korompilias; Emilios Pakos Journal: World J Orthop Date: 2022-06-18