Meta-analysis of Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty

Abstract

Previous meta-analyses established that tranexamic acid confers benefits when used during total hip arthroplasty (THA). However, 2 of these meta-analyses included a variety of routes of administration of tranexamic acid in THA (topical, intravenous, oral, and intra-articular), another meta-analysis included a variety of antifibrinolytic drugs (not restricted to a single drug), and the final meta-analysis included nonrandomized controlled trials. This meta-analysis focused on a single medication, tranexamic acid, administered in a specific way, intravenously in patients undergoing primary THA, using data reported only in randomized controlled studies. Outcomes were restricted to blood loss, allogeneic transfusion rates, and complications. Other outcomes, such as return to function or clinical scores, could not be evaluated because of lack of consistent reporting. To better understand the effects of intravenous tranexamic acid in THA on clinical outcomes, such as recovery, return to function, and patient-reported outcome measures, it would be helpful to have more controlled trials examining these measures in a standardized manner. Intravenous tranexamic acid was beneficial for blood loss intraoperatively, blood loss through drains, and total blood loss during hospitalization, in addition to reducing allogeneic transfusion rates. No difference between intravenous tranexamic acid and placebo was found for most complications, except deep venous thrombosis, which showed favorable results with placebo. [Orthopedics.2016; 39(5):e883-e892.].

What Should Define Preoperative Anemia in Primary THA?

“…In this study, 96% of the patients received TXA (IV or topical), but 11% still received a transfusion despite use of strict transfusion triggers. A recent meta-analysis showed IV TXA was effective in reducing allogenic blood transfusion by 50% and limiting blood loss intraoperatively and through drains in patients undergoing primary THA [27]. Whiting et al [43] recently reported that TXA may be beneficial in patients undergoing total joint arthroplasty regardless of preoperative Hgb, with patients with anemia still seeing transfusion reductions.…”

“…As an additional concern, 24% to 44% of patients presenting for THA are anemic [39]. Although the routine use of tranexamic acid (TXA) has markedly reduced the risk of transfusion after THA, nationally, 10% of patients undergoing THA are still receiving transfusions [2,27]. Furthermore, there is a growing body of evidence to suggest that preoperative anemia and blood transfusion are associated with periprosthetic joint infection, longer length of stay (LOS), and increased risk of complications, and, in some analyses, an increased risk of death in this patient population [5-7, 13, 19, 28].…”

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

“…In THA and TKA, the most notable complication reported in the literature is venous thromboembolism. The vast majority of orthopaedic TXA studies show no increase in the rate of venous thromboembolism events [29][30][31]43,44]. Nishihara, et al is the only study in the recently published literature known to the authors that demonstrated a significant increase in venous thromboembolic events after TXA administration in total joint arthroplasty [18].…”

“…The most common metrics include total blood loss, intra-operative blood loss, post operative blood loss, drain output, hemoglobin reduction, and transfusion rates. Meta analyses comparing studies that use the same metrics for efficacy have widely determined TXA use is superior to placebo controls, however such analyses are rarely, if ever, able to compare studies using the exact same dosing regimens and so their conclusions are typically broadly applicable to the use of TXA but do not delve into the optimal IV and or topical dosing strategies other than speculation [6,7,[29][30][31].…”

Tranexamic Acid - Major Antifibrinolytic Agent Used to Achieve Hemostasis in Hemophilic Patients with Anti-Factor VIII Anti-Bodies Who Must Undergo Total Joint Replecement

“…Regarding the tranexamic acid administration method, its combined (intravenous and topical) administration has been shown to be effective by Yuan et al in a meta-analysis carried out in 2016 on patients who underwent total knee replacement surgery [19]. The superiority of combined tranexamic acid administration in cases of total joint replacement surgery was also demonstrated by Xie et al in a study published in 2016 [20] and supported by Wu et al [21] in a study on the use of tranexamic acid in prosthesis revision.…”