The Efficacy and Safety of Tranexamic Acid Utilization in Total Ankle Arthroplasty: a Systematic Review and Meta-analysis

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2023 Nov 25

PMID 38006436

Authors

Alexander Edelstein

John McDonald

Andrew D Lachance

Margaret Elizabeth Giro

Wonyong Lee

Affiliations

Soon will be listed here.

Abstract

Introduction: There is still a lack of information on the role of Tranexamic acid (TXA) in total ankle arthroplasty (TAA). The purpose of this study is to comprehensively review, consolidate, and analyze findings from existing research on the effectiveness and safety of TXA in TAA.

Materials And Methods: The comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, Web of Science, and Cochrane databases, for original, English-language studies investigating the efficacy and safety of TXA in TAA, through February 2023. Evaluated data for the meta-analysis included estimated blood loss (EBL), change in perioperative hemoglobin, need for transfusion, and complications including DVT/PE, and wound complications.

Results: A total of nine studies were included in this study. In total, 450 TAA were included, with 244 receiving TXA (54.2%) and 206 not receiving TXA (45.8%). TXA in TAA significantly decreased EBL. A significantly lower rate of wound complications in the TXA group with the relative risk (RR) of 0.51. We classified wound complications into wound infection and delayed wound healing/dehiscence. A significant decrease in the rate of wound infection and a tendency showing a decrease in the rate of delayed wound healing/dehiscence in the TXA group were noted: the RR of 0.29, and 0.63, respectively. TXA did not increase the incidence of DVT/PE following TAA.

Conclusions: In conclusion, the utilization of TXA during TAA demonstrated a statistically significant reduction in EBL and relative risk for wound complications. However, further RCTs with larger sample sizes will be necessary to establish a more robust conclusion regarding the efficacy and safety of TXA in TAA.

Level Of Evidence: Level III, systematic review and meta-analysis.

References

Ali M, Hassan A, Shah S, Rashid A, Naguib A . The Effect of Tranexamic Acid on the Outcome of Total Ankle Replacement. Cureus. 2022; 14(7):e26706. PMC: 9360626. DOI: 10.7759/cureus.26706. View

Barrachina B, Lopez-Picado A, Remon M, Fondarella A, Iriarte I, Bastida R . Tranexamic Acid Compared with Placebo for Reducing Total Blood Loss in Hip Replacement Surgery: A Randomized Clinical Trial. Anesth Analg. 2016; 122(4):986-95. DOI: 10.1213/ANE.0000000000001159. View

Borenstein T, Anand K, Li Q, Charlton T, Thordarson D . A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty. Foot Ankle Int. 2017; 39(2):143-148. DOI: 10.1177/1071100717738748. View

Calder J, Freeman R, Domeij-Arverud E, van Dijk C, Ackermann P . Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc. 2016; 24(4):1409-20. PMC: 4823373. DOI: 10.1007/s00167-015-3976-y. View

Draeger R, Singh B, Parekh S . Quantifying normal ankle joint volume: An anatomic study. Indian J Orthop. 2009; 43(1):72-5. PMC: 2739497. DOI: 10.4103/0019-5413.45326. View

Soltani Z, Hanaei S, Dabbagh Ohadi M, Maroufi S, Tayebi Meybodi K, Khademi S . Safety and efficacy of aprotinin versus tranexamic acid for reducing absolute blood loss and transfusion in pediatric patients undergoing craniosynostosis surgery: a randomized, double-blind, three-arm controlled trial. J Neurosurg Pediatr. 2022; 29(5):551-559. DOI: 10.3171/2021.12.PEDS21532. View

Gillette B, Kremers H, Duncan C, Smith H, Trousdale R, Pagnano M . Economic impact of tranexamic acid in healthy patients undergoing primary total hip and knee arthroplasty. J Arthroplasty. 2013; 28(8 Suppl):137-9. DOI: 10.1016/j.arth.2013.04.054. View

Gross C, Hamid K, Green C, Easley M, DeOrio J, Nunley J . Operative Wound Complications Following Total Ankle Arthroplasty. Foot Ankle Int. 2017; 38(4):360-366. DOI: 10.1177/1071100716683341. View

Hourlier H, Fennema P . Single tranexamic acid dose to reduce perioperative morbidity in primary total hip replacement: a randomised clinical trial. Hip Int. 2013; 24(1):63-8. PMC: 6159839. DOI: 10.5301/hipint.5000090. View

10.

Johns W, Walley K, Seedat R, Jackson 3rd B, Boukhemis K, Gonzalez T . Tranexamic Acid Use in Foot and Ankle Surgery. Foot Ankle Orthop. 2022; 5(4):2473011420975419. PMC: 8564923. DOI: 10.1177/2473011420975419. View

11.

Moore A, Smith B, OLeary R, Hoch C, Gross C, Scott D . Tranexamic Acid Associated With Less Wound Complications in Ankle and Hindfoot Surgery: Level III, Retrospective Cohort Study. J Am Acad Orthop Surg. 2022; 30(16):789-797. DOI: 10.5435/JAAOS-D-21-01064. View

12.

Munn Z, Moola S, Riitano D, Lisy K . The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int J Health Policy Manag. 2014; 3(3):123-8. PMC: 4154549. DOI: 10.15171/ijhpm.2014.71. View

13.

Poeran J, Rasul R, Suzuki S, Danninger T, Mazumdar M, Opperer M . Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ. 2014; 349:g4829. PMC: 4130961. DOI: 10.1136/bmj.g4829. View

14.

Salameh M, Attia A, El Khatib S, Hantouly A, Hsu R, Blankenhorn B . Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis. Foot Ankle Int. 2022; 43(10):1370-1378. DOI: 10.1177/10711007221114139. View

15.

Shah J, Schwartz A, Farley K, Mahmoud K, Attia A, Labib S . Projections and Epidemiology of Total Ankle and Revision Total Ankle Arthroplasty in the United States to 2030. Foot Ankle Spec. 2022; :19386400221109420. DOI: 10.1177/19386400221109420. View

16.

Steinmetz R, Luick L, Tkach S, Falcon S, Stoner J, Hollabaugh K . Effect of Tranexamic Acid on Wound Complications and Blood Loss in Total Ankle Arthroplasty. Foot Ankle Int. 2020; 41(9):1117-1121. DOI: 10.1177/1071100720934889. View

17.

Sterne J, Savovic J, Page M, Elbers R, Blencowe N, Boutron I . RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. DOI: 10.1136/bmj.l4898. View

18.

Tan G, Xie L, Yi S, Chen Y, Liu X, Zhang H . The efficacy and safety of intravenous tranexamic acid on blood loss during total ankle replacement: a retrospective study. Sci Rep. 2022; 12(1):9542. PMC: 9184638. DOI: 10.1038/s41598-022-13861-3. View

19.

Tuttle J, Ritterman S, Cassidy D, Anazonwu W, Froehlich J, Rubin L . Cost benefit analysis of topical tranexamic acid in primary total hip and knee arthroplasty. J Arthroplasty. 2014; 29(8):1512-5. DOI: 10.1016/j.arth.2014.01.031. View

20.

Xie B, Tian J, Zhou D . Administration of Tranexamic Acid Reduces Postoperative Blood Loss in Calcaneal Fractures: A Randomized Controlled Trial. J Foot Ankle Surg. 2015; 54(6):1106-10. DOI: 10.1053/j.jfas.2015.07.006. View