The optimal regimen of oral tranexamic acid administration for primary total knee/hip replacement: a meta-analysis and narrative review of a randomized controlled trial

Abstract

Background Oral tranexamic acid (TXA) has been demonstrated to reduce the blood loss in primary total knee and hip arthroplasty, but the optimal regimen of oral TXA administration is still unknown. This study aimed to find the best number of administrations of oral TXA for primary total knee and hip arthroplasty. Methods The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published before March 20, 2020. Studies clearly reporting a comparison of multiple administrations of oral TXA for total hip/knee replacement were included, and the total blood loss (TBL), intraoperative blood loss (IBL), decline in hemoglobin (DHB), deep vein thrombosis (DVT), intramuscular venous thrombosis (IVT), length of hospital stay (LOS), and transfusion rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed effects or random effects model. Results Nine studies involving 1678 patients were included in this meta-analysis (TXA 1363 (one administration, 201; two administrations, 496; three administrations, 215; four administrations, 336; five administrations, 115); placebo 315); the results show that compared with placebo groups, oral TXA could significantly reduce the TBL, IBL, DHB, LOS, and transfusion rate. In addition, the incidences of IVT and DVT were similar between the TXA and placebo groups. Moreover, two administrations of oral TXA significantly reduced the TBL and DHB compared with one administration, three administrations of oral TXA were better than two administrations, and four administrations of oral TXA were better than three administrations. Conclusion Our results suggested that oral TXA could significantly reduce the blood loss and the length of hospital stay but could not increase the incidence of DVT and IVT for total joint replacement patients; additionally, the effectiveness of oral TXA administration increased as the number of administrations increased.

Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram

“…Evidence shows that the safety and effectiveness of tranexamic acid play an important role in the fast-track procedures [ 20 ]. TXA stabilizes fibrin clots by binding plasmin to fibrin to inhibit plasminogen activation, resulting in more stable hemostasis [ 21 ]. Yang et al [ 22 ] confirmed that after the application of TXA, the blood transfusion rate of hip replacement decreased from 22.4 to 5.7%.…”

The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis

“…Although several meta-analyses have compared the bloodsparing effects of TXA and EACA, the enrolled patients consisted of total hip arthroplasty and total knee arthroplasty, which may lead to confounding results. [16][17][18] Another two studies did not take the dosage of antifibrinolytic drugs into account and only focus on the intravenous administration. 19,20 Fillingham et al 21 compared the efficacy of different administrations of TXA regarding the blood loss after total knee arthroplasty but did not make comparison among the EACA.…”

“…Intravenous (IV) or intra‐articular (IA) administrations of TXA and EACA were most commonly used and studied, but the optimal dosage and efficacy of TXA and EACA to control bleeding for patients after unilateral TKA are still controversial. Although several meta‐analyses have compared the blood‐sparing effects of TXA and EACA, the enrolled patients consisted of total hip arthroplasty and total knee arthroplasty, which may lead to confounding results 16–18 . Another two studies did not take the dosage of antifibrinolytic drugs into account and only focus on the intravenous administration 19,20 .…”

Peri-articular administration of tranexamic acid is an alternative route in total knee arthroplasty: a systematic review and meta-analysis

“…Total knee arthroplasty (TKA) is a safe and reliable surgical procedure for patients with osteoarthritis, rheumatoid arthritis, or fractures [1][2][3]. Due to the ageing of its population, the annual demand for knee joint replacement continues to grow in the USA [4].…”