Reduced Blood Loss After Intra-articular Tranexamic Acid Injection During Total Knee Arthroplasty: a Meta-analysis of the Literature

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2013 Dec 20

PMID 24352523

Citations 25

Authors

Chen Zhao-Yu

Gao Yan

Chen Wei

Liu Yuejv

Zhang Ying-ze

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of the study is to conduct a meta-analysis of randomized, controlled trials evaluating the efficacy and safety of intra-articular injection of tranexamic acid (TXA) for reducing blood loss and transfusion in patients undergoing total knee arthroplasty (TKA).

Methods: A meta-analysis was conducted of RCTs published before March 2013, identified from the PubMed, EMBase, Cochrane library, ScienceDirect, and other databases. Two independent reviewers assessed the methodological quality of the studies and performed data extraction. Mean difference in blood loss and blood transfusions, risk ratios of transfusion rates, and deep vein thrombosis (DVT) incidence in the TXA-treated group versus placebo group were pooled from the included studies. Data were analysed using Stata 11.0 software.

Results: Six studies were included, with a total sample size of 647 patients. The use of TXA significantly reduced total blood loss (mean difference: -344.96; 95% confidence interval (CI) -401.20 to -239.68; P < 0.01) and the proportion of patients requiring blood transfusions (risk ratios, 0.28; 95% CI: 0.19-0.42; P < 0.01). There were no significant differences in the incidence of DVT, pulmonary embolism, or other complications between the study groups.

Conclusions: The present meta-analysis indicated that intra-articular injection of TXA in patients undergoing TKA may reduce total blood loss and the need for blood transfusions, particularly when a high dosage of TXA is used (≥30 mg/ml), without any increase in the risk of post-operative DVT.

Level Of Evidence: II.

Citing Articles

Impact of enhanced recovery after surgery on postoperative blood management following primary total knee arthroplasty: a propensity score-matched analysis.

Mogalli A, Zhao J, Chen Y, Qi X Int Orthop. 2024; 49(1):53-63.

PMID: 39387884 DOI: 10.1007/s00264-024-06342-x.

Enhanced recovery after surgery (ERAS) protocols for total joint replacement surgery.

Riga M, Altsitzioglou P, Saranteas T, Mavrogenis A SICOT J. 2023; 9:E1.

PMID: 37819173 PMC: 10566339. DOI: 10.1051/sicotj/2023030.

Does the accelerometer-based navigation system reduce blood loss and transfusion in one-stage sequential bilateral total knee arthroplasty? A randomized double-blind controlled trial.

Jarusriwanna A, Pornrattanamaneewong C, Narkbunnam R, Ruangsomboon P, Thitithapana P, Chareancholvanich K BMC Musculoskelet Disord. 2023; 24(1):531.

PMID: 37386413 PMC: 10308745. DOI: 10.1186/s12891-023-06648-8.

Key Elements of Enhanced Recovery after Total Joint Arthroplasty: A Reanalysis of the Enhanced Recovery after Surgery Guidelines.

Changjun C, Xin Z, Yue L, Liyile C, Pengde K Orthop Surg. 2023; 15(3):671-678.

PMID: 36597677 PMC: 9977593. DOI: 10.1111/os.13623.

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis.

Hong P, Liu R, Rai S, Liu J, Ding Y, Li J Front Pharmacol. 2022; 13:887386.

PMID: 35662737 PMC: 9160460. DOI: 10.3389/fphar.2022.887386.

References

Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y . Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011; 35(11):1639-45. PMC: 3193960. DOI: 10.1007/s00264-010-1205-3. View

Wong J, Abrishami A, El Beheiry H, Mahomed N, Davey J, Gandhi R . Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am. 2010; 92(15):2503-13. DOI: 10.2106/JBJS.I.01518. View

Rajesparan K, Biant L, Ahmad M, Field R . The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009; 91(6):776-83. DOI: 10.1302/0301-620X.91B6.22393. View

Goodnough L, Verbrugge D, Marcus R . The relationship between hematocrit, blood lost, and blood transfused in total knee replacement. Implications for postoperative blood salvage and reinfusion. Am J Knee Surg. 1995; 8(3):83-7. View

Hardy J, Belisle S . Natural and synthetic antifibrinolytics: inert, poisonous or therapeutic agents?. Can J Anaesth. 1997; 44(9):913-7. DOI: 10.1007/BF03011960. View

Endres S, Heinz M, Wilke A . Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study. BMC Surg. 2011; 11:29. PMC: 3234174. DOI: 10.1186/1471-2482-11-29. View

Zhang H, Chen J, 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. 2011; 20(9):1742-52. DOI: 10.1007/s00167-011-1754-z. View

Baric D, Biocina B, Unic D, Sutlic Z, Rudez I, Vrca V . Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study. Eur J Cardiothorac Surg. 2007; 31(3):366-71. DOI: 10.1016/j.ejcts.2006.12.003. View

Ross J, Salman R . The frequency of thrombotic events among adults given antifibrinolytic drugs for spontaneous bleeding: systematic review and meta-analysis of observational studies and randomized trials. Curr Drug Saf. 2012; 7(1):44-54. DOI: 10.2174/157488612800492744. View

10.

Cardone D, Klein A . Perioperative blood conservation. Eur J Anaesthesiol. 2009; 26(9):722-9. DOI: 10.1097/EJA.0b013e32832c5280. View

11.

Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C . Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?. Anesthesiology. 2006; 105(5):1034-46. DOI: 10.1097/00000542-200611000-00026. View

12.

Gillette B, DeSimone L, Trousdale R, Pagnano M, Sierra R . Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty. Clin Orthop Relat Res. 2012; 471(1):150-4. PMC: 3528901. DOI: 10.1007/s11999-012-2488-z. View

13.

Orpen N, Little C, Walker G, Crawfurd E . Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee. 2006; 13(2):106-10. DOI: 10.1016/j.knee.2005.11.001. View

14.

Roy S, Tanki U, Dutta A, Jain S, Nagi O . Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012; 20(12):2494-501. DOI: 10.1007/s00167-012-1942-5. View

15.

Fawzy H, Elmistekawy E, Bonneau D, Latter D, Errett L . Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial. J Cardiothorac Surg. 2009; 4:25. PMC: 2706826. DOI: 10.1186/1749-8090-4-25. View

16.

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(8):1302-7. DOI: 10.1111/j.1537-2995.2005.00204.x. View

17.

Dillon C, Rasch E, Gu Q, Hirsch R . Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol. 2006; 33(11):2271-9. View

18.

Zanasi S . Innovations in total knee replacement: new trends in operative treatment and changes in peri-operative management. Eur Orthop Traumatol. 2011; 2(1-2):21-31. PMC: 3150806. DOI: 10.1007/s12570-011-0066-6. View

19.

Kagoma Y, Crowther M, Douketis J, Bhandari M, Eikelboom J, Lim W . Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res. 2008; 123(5):687-96. DOI: 10.1016/j.thromres.2008.09.015. View

20.

Bierbaum B, Callaghan J, Galante J, Rubash H, TOOMS R, Welch R . An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999; 81(1):2-10. DOI: 10.2106/00004623-199901000-00002. View