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, IL. 2. Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH. 3. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. 4. Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL. 5. Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA. 6. Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ. 7. Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada. 8. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. 9. Department of Anesthesiology, Hospital for Special Surgery, New York, NY. 10. South Texas Bone and Joint Institute, San Antonio, TX. 11. Institute for Joint Restoration, Fremont, CA.
Abstract
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to reduce blood loss in total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy of TXA in primary THA to support 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: A search was performed using Ovid-MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases to identify all publications before July 2017 on TXA in primary THA. We completed qualitative and quantitative homogeneity testing of all included studies. Direct and indirect comparisons were analyzed using a network meta-analysis followed by consistency testing of the results. RESULTS: Two thousand one hundred thirteen publications underwent critical appraisal with 34 publications identified as representing the best available evidence for inclusion in the analysis. Topical, intravenous, and oral TXA formulations provided reduced blood loss and risk of transfusion compared to placebo, but no formulation was clearly superior. Use of repeat doses, higher doses, or variation in timing of administration did not significantly reduce blood loss or risk of transfusion. CONCLUSIONS: Strong evidence supports the use of TXA to reduce blood loss and risk of transfusion after primary THA. No specific routes of administration, dosage, dosing regimen, or time of administration provides clearly superior blood-sparing properties.
BACKGROUND:Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to reduce blood loss in total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy of TXA in primary THA to support 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: A search was performed using Ovid-MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases to identify all publications before July 2017 on TXA in primary THA. We completed qualitative and quantitative homogeneity testing of all included studies. Direct and indirect comparisons were analyzed using a network meta-analysis followed by consistency testing of the results. RESULTS: Two thousand one hundred thirteen publications underwent critical appraisal with 34 publications identified as representing the best available evidence for inclusion in the analysis. Topical, intravenous, and oral TXA formulations provided reduced blood loss and risk of transfusion compared to placebo, but no formulation was clearly superior. Use of repeat doses, higher doses, or variation in timing of administration did not significantly reduce blood loss or risk of transfusion. CONCLUSIONS: Strong evidence supports the use of TXA to reduce blood loss and risk of transfusion after primary THA. No specific routes of administration, dosage, dosing regimen, or time of administration provides clearly superior blood-sparing properties.
Authors: Jonas Alfitian; Max Joseph Scheyerer; Axel Rohde; Volker Schick; Tobias Kammerer; Robert Schier Journal: Arch Orthop Trauma Surg Date: 2022-06-16 Impact factor: 3.067
Authors: Andrew G Golz; Heather K Yee; Benjamin J Davis; William H Adams; Nicholas M Brown Journal: J Am Acad Orthop Surg Date: 2021-06-01 Impact factor: 4.000