The effectiveness and safety of tranexamic acid in bilateral total knee arthroplasty: A meta-analysis

Kedi Weng, Xingen Zhang, Qing Bi, Chen Zhao, Kedi Weng, Xingen Zhang, Qing Bi, Chen Zhao

Abstract

Objective: A meta-analysis was performed to investigate the effectiveness and safety of tranexamic acid (TXA) for the treatment of blood loss after a bilateral total knee arthroplasty (TKA).

Methods: Patients prepared for bilateral TKA and intervention including TXA versus placebo were comprehensively retrieved from MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from the time of the establishment of these databases to January 2016. The outcomes were all calculated by Stata 12.0 software. The continuous endpoints (total blood loss and blood loss in drainage) were calculated as mean difference (MD) and 95% confidence intervals (CIs). Binary variables (the need for transfusion, and the occurrence of deep venous thrombosis [DVT]) were calculated as relative risk (RR) with 95% CIs.

Results: Pooled results revealed that treatment with TXA associated with less need for transfusion (P = 0.000) and the value of Hb drop postoperatively (P = 0.290) after bilateral TKA. The results also indicated that TXA can decrease the total blood loss and blood loss in drainage after bilateral TKA (P < 0.05). Meanwhile, TXA can decrease the blood units transfused per patient by 1.23 U (P = 0.001). There is no statistically significant difference in terms of the occurrence of DVT between the 2 groups (P = 0.461).

Conclusion: Based on the current evidence, TXA can decrease the need for transfusion and the total blood loss without increasing the occurrence of DVT, and its administration is recommended routinely in bilateral TKA.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The forest plot compared the TXA versus placebo in terms of need for transfusion. TXA = tranexamic acid.
Figure 2
Figure 2
Funnel plot analysis of potential publication bias (for the 13 articles seen in Fig. 2).
Figure 3
Figure 3
The funnel plot was symmetrical and the P-value calculated by Begg's test was 0.327.
Figure 4
Figure 4
The forest plot compared the TXA versus placebo in terms of Hb drop. TXA = tranexamic acid.
Figure 5
Figure 5
The forest plot compared the TXA versus placebo in terms of total blood loss. TXA = tranexamic acid.
Figure 6
Figure 6
The forest plot compared the TXA versus placebo in terms of blood loss in drainage. TXA = tranexamic acid.
Figure 7
Figure 7
The forest plot compared the TXA versus placebo in terms of blood unit per patient transfused. TXA = tranexamic acid.
Figure 8
Figure 8
The forest plot compared the TXA versus placebo in terms of the occurrence of DVT and PE. DVT = deep venous thrombosis, PE = pulmonary embolism, TXA = tranexamic acid.

References

    1. Bong MR, Patel V, Chang E, et al. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 2004; 19:281–287.
    1. Hiippala S, Strid L, Wennerstrand M, et al. Tranexamic acid (cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth 1995; 74:534–537.
    1. Madjdpour C, Spahn D. Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br J Anaesth 2005; 95:33–42.
    1. Bierbaum BE, Callaghan JJ, Galante JO, et al. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg 1999; 81:2–10.
    1. Cermakova Z, Simetka O, Kořístka M. [Transfusion-related acute lung injury (TRALI)-review]. Ceska gynekologie/Ceska lekarska Spolecnost J Ev Purkyne 2013; 78:211–215.
    1. Martin JG, Cassatt KB, Kincaid-Cinnamon KA, et al. Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplasty 2014; 29:889–894.
    1. Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, et al. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement. J Bone Joint Surg Am 2014; 96:1937–1944.
    1. Fu D, Li G, Chen K, et al. Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplasty 2013; 28:1141–1147.
    1. Bagsby DT, Samujh CA, Vissing JL, et al. Tranexamic acid decreases incidence of blood transfusion in simultaneous bilateral total knee arthroplasty. J Arthroplasty 2015; 30:2106–2109.
    1. Dhillon MS, Bali K, Prabhakar S. Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage. Ind J Orthop 2011; 45:148.
    1. Hegde C, Wasnik S, Kulkarni S, et al. Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty 2013; 28:1888–1891.
    1. Karaaslan F, Karaoğlu S, Mermerkaya MU, et al. Reducing blood loss in simultaneous bilateral total knee arthroplasty: combined intravenous–intra-articular tranexamic acid administration. A prospective randomized controlled trial. Knee 2015; 22:131–135.
    1. Karam JA, Bloomfield MR, DiIorio TM, et al. Evaluation of the efficacy and safety of tranexamic acid for reducing blood loss in bilateral total knee arthroplasty. J Arthroplasty 2014; 29:501–503.
    1. Kim TK, Chang CB, Kang YG, et al. Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2014; 22:1870–1878.
    1. MacGillivray RG, Tarabichi SB, Hawari MF, et al. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty 2011; 26:24–28.
    1. Zhao HL, Wan SG, Qi DZ, et al. Topical hemostatic procedures control blood loss in bilateral cemented single-stage total knee arthroplasty. J Orthop Sci 2014; 19:948–953.
    1. Kelley TC, Tucker KK, Adams MJ, et al. Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty. Transfusion 2014; 54:26–30.
    1. Mutsuzaki H, Ikeda K. Effect of injecting tranexamic acid from a drain to the joint and drain-clamping to reduce blood loss during bilateral cementless total knee arthroplasty. J Blood Disorders Transf 2014; 5:2.
    1. Kakar P, Gupta N, Govil P, et al. Efficacy and safety of tranexamic acid in control of bleeding following TKR: a randomized clinical trial. Ind J Anaesthesia 2009; 53:667.
    1. Raviraj A, Anand A, Chakravarthy M, et al. Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial. Eur J Orthop Surg Traumatol 2012; 22:381–386.
    1. Wang R, Tian SQ, Ha CZ, et al. Efficacy and safety of tranexamic acid on reducing blood loss in bilateral total knee arthroplasty. Chin J Tissue Eng Res 2015; 19:3451–3456.
    1. He Y, Wu H, Wu L, et al. Efficacy and safety of tranexamic acid in treating perioperative blood loss in bilateral total knee arthroplasty (TKA). J Xinjiang Med Univ 2014; 37:1425–1430.
    1. Gu J, Du H, Jiang X, et al. Efficacy and safety of intravenous and intra-articular injection of tranexamic acid in reducing perioperative bleeding during simultaneous bilateral total knee arthroplasty. Shandong Med J 2015; 55:14–16.
    1. Wesley MC, Pereira LM, Scharp LA, et al. Pharmacokinetics of tranexamic acid in neonates, infants, and children undergoing cardiac surgery with cardiopulmonary bypass. Anesthesiology 2015; 122:746–758.
    1. Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty. J Arthroplasty 2014; 29:387–389.
    1. Bhatia S, Deshpande H. Role of tranexamic acid in reducing blood loss during and after caesarean section. Med J Dr DY Patil Univ 2015; 8:21.
    1. Roberts I, Prieto-Merino D, Manno D. Mechanism of action of tranexamic acid in bleeding trauma patients: an exploratory analysis of data from the CRASH-2 trial. Crit Care 2014; 18:685.
    1. Alshryda S, Sukeik M, Sarda P, et al. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J 2014; 96:1005–1015.
    1. Soni A, Saini R, Gulati A, et al. Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty. J Arthroplasty 2014; 29:1525–1527.
    1. Huang Z, Ma J, Shen B, et al. Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2014; 29:2342–2346.
    1. Wang H, Shen B, Zeng Y. Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. Knee 2014; 21:987–993.
    1. Wang H, Shen B, Zeng Y. Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. Knee 2014; 21:987–993.
    1. Aggarwal AK, Singh N, Sudesh P. Topical vs intravenous tranexamic acid in reducing blood loss after bilateral total knee arthroplasty: a prospective study. J Arthroplasty 2016; 31:1442–1448.
    1. MacGillivray RG, Tarabichi SB, Hawari MF, et al. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty 2011; 26:24–28.
    1. Chen X, Cao X, Yang C, et al. Effectiveness and safety of fixed-dose tranexamic acid in simultaneous bilateral total knee arthroplasty: a randomized double-blind controlled trial. J Arthroplasty 2016; [Epub ahead of print].
    1. Levine BR, Haughom BD, Belkin MN, et al. Weighted versus uniform dose of tranexamic acid in patients undergoing primary, elective knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2014; 29 (9 suppl):186–188.
    1. Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Rel Res 2012; 470:2605–2612.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere