The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

Abstract

Objective The present meta-analysis was conducted to evaluate the efficacy and safety of the application of tranexamic acid (TXA) in patients undergoing high tibial osteotomy (HTO). Methods PubMed (MEDLINE), EMBASE, and Cochrane Library were systematically searched for relevant literature from inception until 1 February 2021. A combined searching strategy of subject words and random words was adopted. After testing for potential publication bias and/or heterogeneity, we aggregated variables by using the random-effect model. The primary comparison outcome measures were total blood loss, hemoglobin decrease, drain output, wound complications, thrombotic events, and blood transfusion rate of the TXA group versus control. The meta-analysis was performed using the RevMan 5.3 software. Results A total of 5 studies were included involving 532 patients. The results showed that there were significant differences in the two groups concerning total blood loss (95% confidence interval [CI] − 332.74 to − 146.46, P < 0.00001), hemoglobin decrease on postoperative day (POD) 1, 2, and 5 (POD 1 95% CI − 1.34 to − 0.63, P < 0.00001; POD 2 95% CI − 1.07 to − 0.68, P < 0.00001; POD 5 95% CI − 1.46 to − 0.84, P < 0.00001), drain output (POD total 95% CI − 195.86 to − 69.41, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 0.46, 95% CI 0.09 to 2.41, P = 0.36) and blood transfusion rate (RR = 0.25, 95% CI 0.03 to 2.27, P = 0.22). Conclusions This meta-analysis of the available evidence demonstrated that TXA could reduce total blood loss, hemoglobin decrease, drain output, and wound complications without increasing the incidence of thromboembolic events in patients undergoing HTO. But there is no obvious evidence that TXA could reduce blood transfusion rates. Further studies, including more large-scale and well-designed randomized controlled trials, are warranted to assess the efficacy and safety issues of routine TXA use in HTO patients.

Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

“…There are several other indications for TXA, as it demonstrates reduced blood loss in high tibial osteotomy [48], peri-acetabular osteotomy [49], elbow arthrolysis [50], and spine surgery [51,52,53]. Further research on TXA in orthopaedic surgery should therefore concentrate on administration routes as well as duration of TXA treatment for optimal effect.…”

Utilization of Tranexamic Acid in Surgical Orthopaedic Practice: Indications and Current Considerations

“… 72–75 The most recent of these studies, a meta-analysis by Ma et al, also demonstrated reduced incidence of wound complications and smaller decreases of postoperative hemoglobin in patients receiving TXA, however these results contrasted from an earlier meta-analysis by Yao et al that indicated no difference in wound complication rates in patients receiving TXA versus placebo during HTO. 73 , 74 This observed contrast in results highlights the need for larger and more robust studies to evaluate the true impact of TXA in patient outcomes in sports medicine procedures such as ACLR and HTO.…”

“… - No significant difference in the efficacies of reducing hemarthrosis, joint pain and swelling was found between intravenous administration and intra-articular injection. Ma et al, 2021 74 HTO Meta analysis 5 studies 532 patients In high tibial osteotomy, the use of TXA demonstrated reduced incidence of wound complications and smaller decreases of postoperative hemoglobin. Li et al, 2020 72 HTO Retrospective case control study 24 patients in the combined group and 21 in the solo group.…”

Letter to editor regarding “The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis”

“…We read a recent published meta-analysis [ 1 ] with great interest, which entitled “The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis.” Coincidentally, with a similar analysis we did recently, we have some concerns about reported results and want to share our opinions as well.…”