The efficacy of topical tranexamic acid in total hip arthroplasty: a meta-analysis

Abstract

AbstractsBackgroundTopical tranexamic acid (TXA) has been shown to be effective in reducing blood loss and the need for transfusion after total knee arthroplasty. However, the effectiveness of topical TXA use in total hip arthroplasty (THA) still remains unclear. The purpose of this meta-analysis is to examine the safety and efficacy of topical use of TXA following THA.Hypothesis: Topical TXA reduces blood loss and transfusion rates without increasing risk of deep vein thrombosis in patients with THA.MethodsAn electronic literature search of PubMed, Embase, the Cochrane Library, Web of Science and Chinese Biomedical Database was performed, to identify studies published before February 2015. All randomized controlled trials and cohort studies evaluating the efficacy of topical TXA during THA were included. Two independent authors identified the eligible studies, assessed their methodological quality, and extracted data. The data were using fixed-effects or random-effects models with (standard) mean differences and risk ratios for continuous and dichotomous variables, respectively. Data were analysed using RevMan 5.3 software.ResultsFourteen studies encompassing 2594 patients met the inclusion criteria for our meta-analysis. Our meta-analysis indicated that when compared with the placebo group, topical use of TXA significantly reduced total blood loss (MD = −297.65 ml, 95 % CI −371.68 ml, 116.08 ml; P < 0.01), drainage loss (MD = −164.68 ml, 95 % CI −236.63 ml, −92.73 ml; P < 0.01), transfusion rate (RR = 0.26, 95 % CI 0.17, 0.40; P < 0.01) and with less of a drop in haemoglobin level (SMD = −0.66, 95 % CI −0.91, −0.41; P < 0.01) after primary THA. No significant difference in length of hospital stay (MD = −0.40, 95 % CI −0.91, 0.11; P = 0.14), deep vein thrombosis (RR = 1.19, 95 % CI 0.40, 3.57; P = 0.16) and pulmonary embolism (RR = 1.11, 95 % CI 0.11, 10.81; P = 0.21) among the study groups.ConclusionsTopical TXA could significantly reduce total blood loss, drainage loss, transfusion rates and decrease haemoglobin level following THA, without increasing risk of venous thromboembolisms.

A systematic review of tranexamic acid in hip fracture surgery

“…A lack of systemic absorption with topical TXA is one suggested reason for such an effect. Comparable results have previously been identified with topical TXA in hip and knee arthroplasty . Caution should exercised, however, when considering use in hemiarthroplasty, as recent research has identified a potential cytotoxic effect on chondrocytes in an animal model .…”

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].…”

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

“…Evangelista et al [31] reported an elevated risk of deep vein thrombosis and pulmonary embolism after application of TXA. However, several meta-analyses showed TXA might not increase thromboembolic events in patients undergoing THA and the incidence of thromboembolic events was very low [30,[32][33][34][35]. Lucas-Polomeni et al [36] reported drug allergy with anaphylactic shock after intravenous TXA.…”