The efficacy of combined intra-articular and intravenous tranexamic acid for blood loss in primary total knee arthroplasty

Abstract

Background:This meta-analysis aimed to illustrate the efficacy and safety of combined topical and intravenous (IV) tranexamic acid (TXA) for blood loss control in primary total knee arthroplasty (TKA) patients.Methods:In April 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for TKA surgery in studies that compared combined topical and IV TXA versus placebo, topical, or IV TXA alone were retrieved. The primary endpoint was the need for transfusion, total blood loss, hemoglobin drop, and the occurrence of deep venous thrombosis (DVT), pulmonary embolism (PE), and the infection. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.Results:Seven clinical studies were ultimately included in the meta-analysis. Compared with IV TXA and control group, combined TXA was associated with less need for transfusion, blood loss, and hemoglobin drop (P < .05). There was no significant difference between the combined TXA and topical TXA in terms of the need for transfusion, total blood loss, and hemoglobin drop (P > .05). There was no significant difference between the complications (DVT, PE, and infection) between the combined TXA, IV TXA, topical TXA, and control group.Conclusions:Current meta-analysis suggests that the combined IV and topical TXA was superior than IV TXA or control group. There is still need for more studies to identify whether combined TXA was superior than topical TXA alone.

Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah’s Witness patients?

“…[ 24 - 30 ] However, in a recent meta-analysis, the combined use of TXA (both IV and topical) has been shown to be more effective over IV use only. [ 31 ] Consistently, a combined TXA application was carried out in our protocol. However, topical TXA was prepared as a cocktail together with ropivacaine hydrochloride and diclofenac sodium and applied not only by pouring it into the wound but through periarticular injection.…”

Comparison of Intravenous and Intra-Articular Use of Tranexamic Acid on Blood Loss after Primary Total Knee Arthroplasty

“…Yuhui Wang et al concluded that intraarticular injection of tranexamic acid has significant hemostatic effect for TKA surgery and it can effectively reduce the occult blood loss, postoperative drainage volume as well as total blood loss and prevent the incidence of deep venous thrombosis and improve the prognosis in patients of practical application value [12].…”

Efficacy of Tranexamic Acid in Reducing Blood Loss in Total Knee Arthroplasty

“…Even when tourniquets are used in TKA, there is considerable bleeding and this procedure may even be considered controversial. 3 Zhang et al 4 demonstrated that when the tourniquet is released, fibronolysis is activated at the site, increasing blood loss. 2 …”