Clinical Use of Tranexamic Acid in High Tibial Osteotomy: A Systematic Review and Meta-analysis

Abstract

Background: High tibial osteotomy (HTO) can cause postoperative hemorrhage. The use of tranexamic acid to reduce the hemorrhage is still controversial. Purpose: To investigate the efficacy and safety of tranexamic acid in HTO. Study Design: Systematic review; Level of evidence, 4. Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted a comprehensive search of the Embase, Cochrane Library, PubMed, Web of Science, MEDLINE, and Foreign Medical Literature Retrieval Service databases between their inception and January 1, 2023. All clinical studies comparing the use of tranexamic acid versus no tranexamic acid during HTO were collected. The primary outcome measures were hemoglobin decrease, drainage volume, and blood loss, and the secondary outcome measures were wound complications, blood transfusion, and postoperative thrombosis. All indicators were analyzed using meta-analysis software. Results were reported as mean differences or risk ratios with 95% confidence intervals. Results: Of 152 initial results, 9 studies involving 908 patients were included. The tranexamic acid group had lower indicators for total blood loss, hemoglobin decrease, and total drainage volume ( P < .00001 for all). There were no differences between patients with versus without tranexamic acid in wound complications, including hematoma ( P = .21) or infection ( P = .18), nor were there any group differences in the prevalence of blood transfusion ( P = .21) or postoperative thrombosis ( P = .36). Conclusion: Tranexamic acid was able to effectively reduce postoperative hemorrhage in patients undergoing HTO without affecting the rates of wound complications, blood transfusion, or postoperative thrombosis.

Postoperative management following osteotomies around the knee: a narrative review

“…A systematic review by Bierke et al confirmed a lower hemoglobin decrease, less total blood loss and lower drainage volume when using TXA during osteotomies at knee level, compared to control groups not using TXA ( 30 ). Similar results are published in several other systematic reviews and meta-analyses focusing on HTO ( 31 , 32 , 33 , 34 ). A current trend to perform osteotomies without tourniquet use may be deduced from literature on TKA procedures but further high-quality studies must be carried out for osteotomy procedures to provide evidence for this topic.…”