Comparison of the Effectiveness and Safety of Topical Versus Intravenous Tranexamic Acid in Primary Total Knee Arthroplasty: a Meta-analysis of Randomized Controlled Trials

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2017 Jan 21

PMID 28103911

Citations 14

Authors

Tao-Ping Chen

Yu-Min Chen

Jian-Bao Jiao

Yun-Fei Wang

Li-Gang Qian

Zhao Guo

Zheng Ma

Cui-Yu Han

Tong-Huan Shi

Affiliations

Soon will be listed here.

Abstract

Background: This study aims to compare the effectiveness and safety of topical versus intravenous tranexamic acid (TXA) in reducing blood loss in primary total knee arthroplasty (TKA).

Methods: PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedicine Literature (CBM), Wanfang Database and China National Knowledge Infrastructure (CNKI), and Google Scholar were searched for randomized controlled studies (RCTs) that compared topical versus intravenous TXA in terms of reducing blood loss during TKA from their inception to September 2015. This systematic review and meta-analysis was performed according to PRISMA criteria.

Results: Twelve studies reporting 12 RCTs comprising 1130 patients were included. Compared with the intravenous administration of TXA, the topical administration of TXA showed no significant differences in total blood loss (MD 2.08, 95% CI -68.43 to 72.60, P = 0.95), blood loss in drainage (MD 18.49, 95% CI -40.01 to 76.98, P = 0.54), hidden blood loss (MD 4.75, 95% CI -337.94 to 347.44, P = 0.99), need for transfusion (RR = 0.92, 95% CI 0.67~1.25, P = 0.58), hemoglobin (Hb) decline (MD -0.42, 95% CI -0.89 to 0.05, P = 0.08), and DVT occurrence (RR = 1.17, 95% CI 0.55~2.50, P = 0.68).

Conclusions: Compared with intravenous administration TXA, topical administration TXA exhibits comparable effectiveness and safety in terms of reducing blood loss during TKA. Due to the poor quality of the included studies, more high-quality RCTs are needed to identify the optimal method and dose of TXA after TKA.

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Impact of intra-articular injection with tranexamic acid on total blood loss and postoperative pain after arthroscopic rotator cuff repair surgery.

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The limited use of a tourniquet during total knee arthroplasty under a contemporary enhanced recovery protocol has no meaningful benefit: a prospective randomized controlled trial.

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Reply to the Letter to the Editor: Combined Intravenous and Intraarticular Tranexamic Acid Does Not Offer Additional Benefit Compared with Intraarticular Use Alone in Bilateral TKA: A Randomized Controlled Trial.

Meshram P, Palanisamy J, Seo J, Lee J, Kim T Clin Orthop Relat Res. 2020; 478(4):912-914.

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Combined Intravenous and Intraarticular Tranexamic Acid Does Not Offer Additional Benefit Compared with Intraarticular Use Alone in Bilateral TKA: A Randomized Controlled Trial.

Meshram P, Palanisamy J, Seo J, Lee J, Kim T Clin Orthop Relat Res. 2019; 478(1):45-54.

PMID: 31498264 PMC: 7000050. DOI: 10.1097/CORR.0000000000000942.

References

Patel J, Spanyer J, Smith L, Huang J, Yakkanti M, Malkani A . Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty. 2014; 29(8):1528-31. DOI: 10.1016/j.arth.2014.03.011. View

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(6):987-93. DOI: 10.1016/j.knee.2014.09.010. View

Jawhar A, Hermanns S, Ponelies N, Obertacke U, Roehl H . Tourniquet-induced ischaemia during total knee arthroplasty results in higher proteolytic activities within vastus medialis cells: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2015; 24(10):3313-3321. DOI: 10.1007/s00167-015-3859-2. 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

Bong M, Patel V, Chang E, Issack P, Hebert R, Di Cesare P . Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty. 2004; 19(3):281-7. DOI: 10.1016/j.arth.2003.10.013. View

Digas G, Koutsogiannis I, Meletiadis G, Antonopoulou E, Karamoulas V, Bikos C . Intra-articular injection of tranexamic acid reduce blood loss in cemented total knee arthroplasty. Eur J Orthop Surg Traumatol. 2015; 25(7):1181-8. DOI: 10.1007/s00590-015-1664-8. View

Aguilera X, Martinez-Zapata M, Hinarejos P, Jordan M, Leal J, Gonzalez J . Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial. Arch Orthop Trauma Surg. 2015; 135(7):1017-25. DOI: 10.1007/s00402-015-2232-8. View

Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S . Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br. 2001; 83(5):702-5. DOI: 10.1302/0301-620x.83b5.11745. View

Jorn L, Lindstrand A, Toksvig-Larsen S . Tourniquet release for hemostasis increases bleeding. A randomized study of 77 knee replacements. Acta Orthop Scand. 1999; 70(3):265-7. DOI: 10.3109/17453679908997804. View

10.

Li Z, Fu X, Tian P, Liu W, Li Y, Zheng Y . Fibrin sealant before wound closure in total knee arthroplasty reduced blood loss: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2014; 23(7):2019-25. DOI: 10.1007/s00167-014-2898-4. View

11.

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

12.

Martin J, Cassatt K, Kincaid-Cinnamon K, Westendorf D, Garton A, Lemke J . Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplasty. 2013; 29(5):889-94. DOI: 10.1016/j.arth.2013.10.005. View

13.

Sehat , Evans , Newman . How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee. 2000; 7(3):151-155. DOI: 10.1016/s0968-0160(00)00047-8. View

14.

Maniar R, Kumar G, Singhi T, Nayak R, Maniar P . Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012; 470(9):2605-12. PMC: 3830076. DOI: 10.1007/s11999-012-2310-y. View

15.

Ho K, Ismail H . Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care. 2003; 31(5):529-37. DOI: 10.1177/0310057X0303100507. View

16.

Madjdpour C, Spahn D . Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br J Anaesth. 2004; 95(1):33-42. DOI: 10.1093/bja/aeh290. View

17.

Lotke P, Faralli V, Orenstein E, Ecker M . Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am. 1991; 73(7):1037-40. View

18.

Higgins J, Thompson S, Deeks J, Altman D . Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414):557-60. PMC: 192859. DOI: 10.1136/bmj.327.7414.557. View

19.

Sabatini L, Atzori F, Revello S, Scotti L, Debiasi F, Masse A . Intravenous use of tranexamic acid reduces postoperative blood loss in total knee arthroplasty. Arch Orthop Trauma Surg. 2014; 134(11):1609-14. DOI: 10.1007/s00402-014-2081-x. View

20.

Kim T, Chang C, Koh I . Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2013; 22(8):1849-58. DOI: 10.1007/s00167-013-2487-y. View