A Systematic Review and Meta-Analysis of the Use of Antifibrinolytic Agents in Total Hip Arthroplasty

Huang, Fei; Wu, Yunfeng; Yin, Zhou; Ma, Guangwen; Chang, Jun

doi:10.5301/hipint.5000285

Cited by 29 publications

(19 citation statements)

References 46 publications

(87 reference statements)

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“…TXA, a hemostatic, is often used to prevent perioperative bleeding in TKA/THA [32]. However, the antifibrinolytic effect of TXA may increase the risk of DVT [33]. Anticoagulant drugs should be given within 6-12 hours after the application of TXA [34].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

Bo¹,

Jiang²,

Deng³

et al. 2020

Preprint

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Purpose To evaluate the efficacy and safety of tranexamic acid combined with rivaroxaban in prevention of clinical events in patients after TKA/THA through meta-analysis of randomized controlled trials. Materials and Methods RCTs were retrieved from medical literature databases. RR, SMD and 95% confidence intervals (CI) were calculated to compare the primary and safety endpoints. Results In total, 16 articles (23 trial comparisons) were retrieved which contained 2179 patients. In general, 1257 patients (57.7%) were randomized to experimental group whereas 922 patients (42.3%) were randomized to control group. The result showed that TXA combined with rivaroxaban significantly reduce TBL, BTV, BTR and the incidence of MB compared to the control group; there were no significant differences in NMB between experimental group and control group. Conclusions This meta-analysis reveals that TXA combined with rivaroxaban can significantly reduce TBL, BTV, the incidence of blood transfusion and the incidence of MB compared to the control group, which proved that its efficacy and safety are trustworthy.

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Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

Bo¹,

Jiang²,

Deng³

et al. 2020

Preprint

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“…Epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) are synthetic amino acid derivatives that promote hemostasis by competitively blocking the lysine-binding site of plasminogen. 1,2 Both drugs are widely used to reduce blood loss and transfusion requirements in orthopedic, hepatic, and cardiac surgery. [2][3][4] To date, the intravenous administration of TXA in total hip arthroplasty (THA) and total knee arthroplasty (TKA) has been well established in the literature.…”

Section: Introductionmentioning

confidence: 99%

Comparison between epsilon-aminocaproic acid and tranexamic acid for total hip and knee arthroplasty: A meta-analysis

Liu

Shen

et al. 2020

J Orthop Surg (Hong Kong)

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Background: The aim was to compare the efficacy and safety of epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) in total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: Potential academic articles were identified from the Cochrane Library, Springer, PubMed, and ScienceDirect databases from inception to December 2019. Randomized controlled trials (RCTs) and non-RCTs involving EACA and TXA in THA or TKA were included. Pooled data were analyzed using RevMan 5.1. Results: Three RCTs and three non-RCTs met the inclusion criteria. The present meta-analysis reveals that EACA is associated with significantly more blood loss than TXA. No significant differences were identified in terms of blood transfusion rate, transfusion units, hemoglobin (Hb) level at discharge, operation time, length of hospital stay, deep venous thrombosis (DVT), or 30-day readmission. Conclusions: Compared with TXA, EACA led to more blood loss in patients undergoing THA or TKA. However, there was no significant difference in the blood transfusion rate, transfusion units, Hb level at discharge, operation time, length of hospital stay, DVT, or 30-day readmission between groups.

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“…Several alternatives are available for minimizing blood loss after THA. These include topical fibrin sealants, topical or intravenous tranexamic acid (TXA) [ 7 , 8 ], aminocaproic acid [ 3 , 9 ] or diluted epinephrine (DEP) [ 10 ]. Recently, administration TXA plus DEP has become popular for THA patients [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness and safety of tranexamic acid plus diluted epinephrine to control blood loss during total hip arthroplasty: a meta-analysis

Zhao

Zhang

2018

J Orthop Surg Res

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BackgroundThe standard protocol to achieve haemostasis during total hip arthroplasty (THA) is uncertain. Tranexamic acid plus diluted epinephrine (DEP) and tranexamic acid (TXA) alone are the two most common alternatives. The purpose of this study was to compare the efficacy and safety of TXA plus DEP to treat blood loss in THA patients.MethodsPublished randomized controlled trials (RCTs) were identified from the following electronic databases: PubMed, Embase, Web of Science, Cochrane Library and Google from inception to July 10, 2018. Studies comparing TXA plus DEP with TXA alone to treat blood loss were included. Either a random-effects model or a fixed-effects model was used for meta-analysis depending on the heterogeneity. We used the need for transfusion as the primary outcome. Stata 12.0 was used for meta-analysis.ResultsSix studies involving 703 patients were included in the present meta-analysis. The pooled results demonstrated that TXA plus DEP was associated with a lower transfusion rate than TXA alone (RR = 0.57, 95% CI 0.38–0.86, P = 0.006). Furthermore, TXA plus DEP was associated with less total blood loss and hidden blood loss by approximately 209.79 ml and 297.74 ml, respectively, than TXA alone. There was no significant difference in terms of intraoperative blood loss or the occurrence of deep venous thrombosis or haematoma between the TXA plus DEP and TXA alone groups (P > 0.05).ConclusionsOur meta-analysis suggested that TXA plus DEP significantly decreased the need for transfusion, total blood loss and hidden blood loss among THA patients. Furthermore, TXA plus DEP did not increase the occurrence of DVT or haemostasis. Additional long-term follow-up RCTs are needed to identify the optimal doses of TXA and DEP.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0948-1) contains supplementary material, which is available to authorized users.

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A Systematic Review and Meta-Analysis of the Use of Antifibrinolytic Agents in Total Hip Arthroplasty

Abstract: Our meta-analysis demonstrated that antifibrinolytic agents significantly reduce blood loss and blood transfusion requirements while not increasing the risk of DVT in patients undergoing total hip arthroplasty.

Cited by 29 publications

References 46 publications

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

Comparison between epsilon-aminocaproic acid and tranexamic acid for total hip and knee arthroplasty: A meta-analysis

Comparative effectiveness and safety of tranexamic acid plus diluted epinephrine to control blood loss during total hip arthroplasty: a meta-analysis

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