The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis

Abstract

PurposeTotal knee arthroplasty (TKA) is a popular procedure in severe osteoarthritis. But perioperative bleeding remains a problem. Floseal® is a mixture of thrombin and bovine gelatin which can benefit a lot on reducing intraoperative and postoperative bleeding. However, there is no enough evidence judging its safety and efficiency. So a meta-analysis is conducted by us to evaluate the efficacy and safety of a thrombin-based hemostatic agent compared with conventional methods in TKA.MethodTwo independent reviewers selected literatures published before August 2014 from MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials. Other internet databases were also performed to identify trials according to the Cochrane Collaboration guidelines. High-quality randomized controlled trials (RCTs), prospective control trials (PCTs), and case controlled trials (CCTs) were selected. The meta-analysis was undertaken using RevMan 5.1 for Windows.ResultsThree RCTs, one PCT, and one CCT met the inclusion criteria. There were significant differences in hemoglobin decline and calculated total blood loss between the Floseal® group and control group. There were no significant differences in postoperative drainage volume, rate of transfusion requirement, incidence of wound infection, deep vein thrombosis (DVT), and pulmonary embolism (PE) between treatment and control groups.ConclusionsThe present meta-analysis indicates that a thrombin-based hemostatic agent can reduce hemoglobin decline and calculated total blood loss after TKA and is not related to adverse reactions or complications such as wound infection, DVT, and PE.

Real‐world surgical outcomes of a gelatin‐hemostatic matrix in women requiring a hysterectomy: a matched case–control study

“…The literature available on other hemostatic agents generally does not suggest increased morbidity subsequent to the use of Floseal, Surgicel or Fibrillar. A meta‐analysis in 2014 evaluating the efficacy of Floseal in total knee arthroplasty patients found no differences in postoperative drainage volume, incidence of wound infection, deep vein thrombosis and pulmonary embolism between Floseal and controls . Similarly, a study comparing post‐thyroidectomy bleeding and infection rates of 98 patients who received Surgicel vs. 92 patients who did not receive Surgicel found similar outcomes .…”

Efficiency and Safety of Intravenous Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

“…Recently, hemostatic agents such as Floseal hemostatic matrix (Baxter International, Chicago, IL, USA), aprotinin and TXA have attracted our attention because of their high efficiency and cost‐effectiveness, as reported in several studies. TXA, a known antifibrinolytic agent, has commonly been used in surgical procedures because of its low cost and allergenicity.…”

Thrombin-Based Hemostatic Agent in Primary Total Knee Arthroplasty

“…In the previous meta-analysis, Wang et al analyzed the efficacy of Floseal in primary TKA. 1 Their review demonstrated that the use of Floseal decreased hemoglobin decline and calculated total blood loss, and did not increase the risk of DVT and pulmonary embolism (PE). However, their findings were limited by a low level of evidence; the review was based largely on RCTs, prospective controlled trials, and case controlled trials.…”