Tze Khiang Tan1, Jenn Yuan Lee2, Aaron Tay3, Markus Kuster3. 1. Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia. khiang94@gmail.com. 2. Royal Perth Hospital, Perth, WA, Australia. 3. Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Abstract
AIM: The ideal route of tranexamic acid (TXA) administration in total hip arthroplasty (THA) or total knee arthroplasty (TKA) remains controversial. This study aims to identify the optima route of TXA administration in THA or TKA. METHODS: PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched until 4 August 2021 for randomised studies that compared intravenous (IV) or intra-articular (IA) administration of TXA in THA or TKA. RESULTS: Sixty-seven studies enrolling 8335 patients (IA: 4162; IV: 4173) were eligible for quantitative and qualitative analysis. Comparable results were demonstrated in the incidence of venous thromboembolisation (OR:0.96, p = 0.84), total blood loss (MD: - 9.05, p = 0.36), drain output (MD: - 7.36, p = 0.54), hidden blood loss (MD: - 6.85, p = 0.47), postoperative haemoglobin level (MD: 0.01, p = 0.91), haemoglobin drop (MD: - 0.10, p = 0.22), blood transfusion rate (OR: 0.99, p = 0.87), total adverse events (OR: 1.12, p = 0.28), postoperative range of motion (MD: 1.08, p = 0.36), postoperative VAS pain score (MD: 0.13, p = 0.24) and postoperative D-dimer level (MD: 0.61, p = 0.64). IV route of TXA administration was associated with significantly longer length of hospital stay compared to IA route of administration (MD: - 0.22, p = 0.01). CONCLUSION: In this meta-analysis, both IV and IA route of TXA administration were equally effective in managing blood loss and postoperative outcomes in lower limb joints arthroplasty. LEVEL OF EVIDENCE: Level 1. PROSPERO Registration CRD42021271355.
AIM: The ideal route of tranexamic acid (TXA) administration in total hip arthroplasty (THA) or total knee arthroplasty (TKA) remains controversial. This study aims to identify the optima route of TXA administration in THA or TKA. METHODS: PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched until 4 August 2021 for randomised studies that compared intravenous (IV) or intra-articular (IA) administration of TXA in THA or TKA. RESULTS: Sixty-seven studies enrolling 8335 patients (IA: 4162; IV: 4173) were eligible for quantitative and qualitative analysis. Comparable results were demonstrated in the incidence of venous thromboembolisation (OR:0.96, p = 0.84), total blood loss (MD: - 9.05, p = 0.36), drain output (MD: - 7.36, p = 0.54), hidden blood loss (MD: - 6.85, p = 0.47), postoperative haemoglobin level (MD: 0.01, p = 0.91), haemoglobin drop (MD: - 0.10, p = 0.22), blood transfusion rate (OR: 0.99, p = 0.87), total adverse events (OR: 1.12, p = 0.28), postoperative range of motion (MD: 1.08, p = 0.36), postoperative VAS pain score (MD: 0.13, p = 0.24) and postoperative D-dimer level (MD: 0.61, p = 0.64). IV route of TXA administration was associated with significantly longer length of hospital stay compared to IA route of administration (MD: - 0.22, p = 0.01). CONCLUSION: In this meta-analysis, both IV and IA route of TXA administration were equally effective in managing blood loss and postoperative outcomes in lower limb joints arthroplasty. LEVEL OF EVIDENCE: Level 1. PROSPERO Registration CRD42021271355.
Authors: Jean Wong; Amir Abrishami; Hossam El Beheiry; Nizar N Mahomed; J Roderick Davey; Rajiv Gandhi; Khalid A Syed; Syed Muhammad Ovais Hasan; Yoshani De Silva; Frances Chung Journal: J Bone Joint Surg Am Date: 2010-11-03 Impact factor: 5.284
Authors: S T Hiippala; L J Strid; M I Wennerstrand; J V Arvela; H M Niemelä; S K Mäntylä; R P Kuisma; J E Ylinen Journal: Anesth Analg Date: 1997-04 Impact factor: 5.108
Authors: Sattar Alshryda; James Mason; Manesh Vaghela; Praveen Sarda; Antoni Nargol; S Maheswaran; Chris Tulloch; Sanjeev Anand; Raj Logishetty; Brian Stothart; A Pali S Hungin Journal: J Bone Joint Surg Am Date: 2013-11-06 Impact factor: 5.284