Tranexamic Acid Reduces Hidden Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Comparative Study and Meta-Analysis

Guang-Ping Huang, Xu-Feng Jia, Zhou Xiang, Yong Ji, Guo-Yong Wu, Yi Tang, Jian Li, Jun Zhang, Guang-Ping Huang, Xu-Feng Jia, Zhou Xiang, Yong Ji, Guo-Yong Wu, Yi Tang, Jian Li, Jun Zhang

Abstract

Background: To explore the efficacy of tranexamic acid (TXA) on reducing hidden blood loss (HBL) in total knee arthroplasty (TKA) by conducting a comparative study and meta-analysis.

Material/methods: A total of 108 patients underwent TKA was equally distributed to experimental and control groups. The only difference between two groups was the administrations of 15 mg of TXA mixed in 100 mL normal saline for experimental group and 100 mL of normal saline for control group. The volumes of blood loss, red blood loss (RBL) were recorded, calculated and analyzed. Stata 12.0 software was applied for data analysis.

Results: The intraoperative and postoperative blood loss volume in experimental group were remarkably reduced compared with those in control group (intraoperative: 105.1±12.1 mL vs. 185.5±20.3 mL, P<0.001; postoperative: 220.7±16.8 mL vs. 290.5±22.4 mL, P<0.001). Accordingly, the control group had significantly higher transfusion rate than experimental group (3.7% vs.25.9%, P=0.001). Our results also found that both the measured and hidden RBL were obviously reduced in experimental group compared with control group (measured RBL: 96.9±11.8 mL vs. 135.2±13.5 mL, P<0.001; hidden RBL: 170.8±37.2 mL vs. 364.2±41.5 mL, P<0.001). Furthermore, meta-analysis confirmed that TXA can notably decrease HBL (SMD=2.68, 95%CI=1.55~3.80, P<0.001).

Conclusions: TXA can significantly reduce the intraoperative and postoperative blood loss and HBL, therefore decreasing the transfusion need in TKA.

Figures

Figure 1
Figure 1
Forest plot comparing the efficacy of tranexamic acid (TXA) and sterile placebo (natrium muriaticum) in reducing hidden blood loss in total knee arthroplasty (TKA).

References

    1. Noble JW, Jr, Moore CA, Liu N. The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty. 2012;27:153–55.
    1. Memtsoudis SG, Chiu YL, Nurok M, et al. Utilization of critical care services among patients undergoing total hip and knee arthroplasty: epidemiology and risk factors. Anesthesiology. 2012;117:107–16.
    1. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007;356:2301–11.
    1. Kagoma YK, Douketis J, Bhandari M, et al. Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res. 2009;123:687–96.
    1. Matsuda K, Nozawa M, Katsube S, et al. Reinfusion of unwashed salvaged blood after total knee arthroplasty in patients with rheumatoid arthritis. Int Orthop. 2009;33:1615–18.
    1. Zhang FJ, Xiao Y, Liu YB, et al. Clinical effects of applying a tourniquet in total knee arthroplasty on blood loss. Chin Med J (Engl) 2010;123:3030–33.
    1. Gao FQ, Li ZJ, Zhang K, et al. Risk factors for lower limb swelling after primary total knee arthroplasty. Chin Med J (Engl) 2011;124:3896–99.
    1. Chareancholvanich K, Siriwattanasakul P, Narkbunnam R, Pornrattanamaneewong C. Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2012;13:124.
    1. Shen HL, Li Z, Feng ML, Cao GL. Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis. Chin Med J (Engl) 2011;124:1653–56.
    1. Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009;91:776–83.
    1. Alcelik I PR, Sukeik M, Bettany-Saltikov J, et al. A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2012;27:331–40.
    1. Eubanks JD. Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg. 2010;18:132–38.
    1. Roy SP, Tanki UF, Dutta A, et al. Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20:2494–501.
    1. MJ C. The use of topical crushed tranexamic acid tablets to control bleeding after dental surgery and from skin ulcers in haemophilia. Haemophilia. 2007;13:443–44.
    1. Dhillon MS, Bali K, Prabhakar S. Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage. Indian J Orthop. 2011;45:148–52.
    1. MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty. 2011;26:24–28.
    1. Wong J, Abrishami A, El Beheiry H, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am. 2010;92:2503–13.
    1. Napolitano LM CM, Cotton BA, Schreiber MA, Moore EE. Tranexamic acid in trauma: how should we use it. J Trauma Acute Care Surg. 2013;74:1575–86.
    1. Lee SH, Cho KY, Khurana S, Kim KI. Less blood loss under concomitant administration of tranexamic acid and indirect factor Xa inhibitor following total knee arthroplasty: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2013;21:2611–17.
    1. Shen PF, Hou WL, Chen JB, et al. Effectiveness and safety of tranexamic acid for total knee arthroplasty: a prospective randomized controlled trial. Med Sci Monit. 2015;21:576–81.
    1. M PN. World Medical Association publishes the Revised Declaration of Helsinki. Natl Med J India. 2014;27:56.
    1. Johansson T, Pettersson LG, Lisander B. Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop. 2005;76:314–19.
    1. Nadler SB HJ, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;58:277–80.
    1. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58:277–80.
    1. Chen H, Manning AK, Dupuis J. A method of moments estimator for random effect multivariate meta-analysis. Biometrics. 2012;68:1278–84.
    1. Jackson D, White IR, Riley RD. Quantifying the impact of between-study heterogeneity in multivariate meta-analyses. Stat Med. 2012;31:3805–20.
    1. Peters JL, Sutton AJ, Jones DR, et al. Comparison of two methods to detect publication bias in meta-analysis. JAMA. 2006;295:676–80.
    1. Zintzaras E, Ioannidis JP. Heterogeneity testing in meta-analysis of genome searches. Genet Epidemiol. 2005;28:123–37.
    1. Camarasa MA, Olle G, Serra-Prat M, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth. 2006;96:576–82.
    1. Fu Z, Zhang J, Yao H. Effect of tranexamic acid on the hidden blood loss after total hip arthroplasty. Journal of Chongqing Medical University. 2012 Apr 2012.
    1. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90:596–99.
    1. Johansson T, Pettersson LG, Lisander B. Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop. 2005;76:314–19.
    1. Zhai P, Sun Y, Sun J. Treating 46 cases of occult blood loss of primary osteoarthritis after the single knee joint replacement with tranexamic acid injection. Rheumatism and Arthritis. 2014:21–24.
    1. Zhang D, Xu J. Preventive effect of tranexamic acid in patients with unilateral total knee arthroplasty perioperative blood loss. Shandong Medical Journal. 2013:56–58.
    1. Zhang Y, Jin Y, Su L, Zhen J. Clinic research on blood loss control by tranexamic acid during primary unilateral total knee replacement. Orthopedic Journal of China. 2013:762–65.
    1. Raleigh E, Hing CB, Hanusiewicz AS, et al. Drain clamping in knee arthroplasty, a randomized controlled trial. ANZ J Surg. 2007;77:333–35.
    1. Zhang H CJ, Chen F, Que W. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2012;20:1742–52.
    1. Vera-Llonch M, Hagiwara M, Oster G. Clinical and economic consequences of bleeding following major orthopedic surgery. Thromb Res. 2006;117:569–77.
    1. Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion. 2005;45:1302–7.
    1. Onodera T, Majima T, Sawaguchi N, et al. Risk of deep venous thrombosis in drain clamping with tranexamic acid and carbazochrome sodium sulfonate hydrate in total knee arthroplasty. J Arthroplasty. 2012;27:105–8.

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