Efficacy of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty: A meta-analysis

Yan Zhang, Jun-Wei Zhang, Bao-Hua Wang, Yan Zhang, Jun-Wei Zhang, Bao-Hua Wang

Abstract

Background: Perioperative blood loss is still an unsolved problem in total knee arthroplasty (TKA). The efficacy of the preoperative use of tranexamic acid (TXA) plus drain-clamping to reduce blood loss in TKA has been debated. This meta-analysis aimed to illustrate the efficacy of TXA plus drain-clamping to reduce blood loss in patients who underwent a TKA.

Methods: In February 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, the Cochrane Database of Systematic Reviews, and Google Scholar. Data from patients prepared for TKA in studies that compared TXA plus drain-clamping versus TXA alone, drain-clamping alone, or controls were retrieved. The primary endpoint was the need for transfusion. The secondary outcomes were total blood loss, blood loss in drainage, the decrease in hemoglobin, and the occurrence of deep venous thrombosis. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.

Results: Ultimately, 5 clinical studies with 618 patients (TXA plus drain-clamping group = 249, control group = 130, TXA-alone group = 60, and drain-clamping group = 179) were included. TXA plus drain-clamping could decrease the need for transfusion, total blood loss, blood loss in drainage, and the decrease in hemoglobin than could the control group, the TXA-alone group, and the drain-clamping group (P < .05). There was no significant difference between the occurrence of deep venous thrombosis between the included groups (P > .05).

Conclusions: TXA plus drain-clamping can achieve the maximum effects of hemostasis in patients prepared for primary TKA. Because the number and the quality of the included studies were limited, more high-quality randomized controlled trials are needed to identify the optimal dose of TXA and the clamping hours in patients prepared for TKA.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
The PRISMA flow chart of retrieved studies. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Risk of bias graph.
Figure 4
Figure 4
Forest plot comparing the need for transfusion between the 2 groups.
Figure 5
Figure 5
Forest plot comparing the total blood loss between the 2 groups.
Figure 6
Figure 6
Forest plot comparing the blood loss in drainage between the 2 groups.
Figure 7
Figure 7
Forest plot comparing the decrease in hemoglobin between the 2s groups.
Figure 8
Figure 8
Forest plot comparing the occurrence of deep venous thrombosis (DVT) between the 2 groups.
Figure 9
Figure 9
Begg test for need for transfusion.
Figure 10
Figure 10
Funnel plot of the need for transfusion.

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