Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis

Rajiv Gandhi, Heather M K Evans, Safiyyah R Mahomed, Nizar N Mahomed, Rajiv Gandhi, Heather M K Evans, Safiyyah R Mahomed, Nizar N Mahomed

Abstract

Background: Tranexamic acid (TXA) is an antifibrinolytic drug used as a blood-sparing technique in many surgical specialties. The principal objective of our meta-analysis was to review randomized, controlled trials (RCT) comparing total blood loss and the number of patients receiving allogeneic blood transfusions with and without the use of TXA for knee (TKA) and hip (THA) arthroplasty.

Methods: Studies were included if patients underwent primary unilateral TKA or THA; the study involved the comparison of a TXA treatment group to a control group who received either a placebo or no treatment at all; outcome measures included total blood loss TBL, number of patients receiving allogeneic blood transfusions, and/or incidence of thromboembolic complications; the study was a published or unpublished RCT from 1995 - July 2012.

Results: Data were tested for publication bias and statistical heterogeneity. Combined weighted mean differences in blood loss favoured TXA over control for TKA and THA patients respectively [ -1.149 (p < 0.001; 95% CI -1.298, -1.000), -0.504 (p < 0.001; 95% CI, -0.672, -0.336)]. Combined odds ratios favoured fewer patients requiring allogeneic transfusions for TKA and THA with the use of TXA respectively [0.145 (p < 0.001; 95% CI, 0.094, 0.223), 0.327 (p < 0.001; 95% CI, 0.208, 0.515)]. Combined odds ratios indicated no increased incidence of DVT with TXA use in TKA and THA respectively [1.030 (p = 0.946; 95% CI, 0.439, 2.420), 1.070 (p = 0.895; 95% CI, 0.393, 2.911)].

Conclusions: TXA should be considered for routine use in primary knee and hip arthroplasty to decrease blood loss.

Figures

Figure 1
Figure 1
Funnel plot of standard error by weighted difference in means.
Figure 2
Figure 2
Funnel plot of standard error by log odds ratio.
Figure 3
Figure 3
Forest plot of combined WMD values for total blood loss in knee arthroplasty.
Figure 4
Figure 4
Forest plot of combined WMD values for total blood loss in hip arthroplasty.
Figure 5
Figure 5
Forest plot of combined OR values for the number of patients requiring allogeneic transfusions in knee arthroplasty studies.
Figure 6
Figure 6
Forest plot of combined OR values for the number of patients requiring allogeneic transfusions in hip arthroplasty studies.
Figure 7
Figure 7
Forest plot of combined OR values for the number of patients who developed a DVT in knee arthroplasty studies.
Figure 8
Figure 8
Forest plot of combined OR values for the number of patients who developed a DVT in hip arthroplasty studies.

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