Topical administration of tranexamic acid in total hip arthroplasty: A meta-analysis of Randomized Controlled Trials

Abstract

Tranexamic acid (TXA) is an antifibrinolytic drug which has been widely used in many areas of surgery. The purpose of our meta-analysis was to review randomized controlled trials (RCT) of the effectiveness and safety of topical TXA treatment in reducing total blood loss and transfusion rate for patients undergoing primary total hip arthroplasty (THA). A literature search was undertaken. Five eligible reports match the inclusion and exclusion standard. The topical administration of TXA groups revealed lower total blood loss(mean difference - 347 ml, 95% CI, - 411 to - 282 mL; p < 0.00001) and transfusion rate (OR, 0.23 (p < 0.00001; 95% CI, 0.14-0.38)) compared with control groups. Meanwhile there was no statistically significant difference in the risk of developing thromboembolic events (OR, 1.64 (95% CI, 0.39-6.97); p = 0.5). Topical administration of TXA could significantly reduce total blood loss and transfusion requirements in primary THA, without increased thromboembolic complications.

Intravenous Tranexamic Acid for Reducing Perioperative Blood Loss During Revision Surgery for Vancouver Type B Periprosthetic Femoral Fractures After Total Hip Arthroplasty: A Retrospective Study

“…The optimal dosage, time points, and frequency of use of tranexamic acid remain to be explored. At the same time, it may be worthwhile investigating the efficacy and safety of oral, topical, or combined administration of tranexamic acid, which has been reported in primary hip arthroplasty. Oral and topical administration may be a safe alternative for patients with contraindications to intravenous administration.…”

Intravenous Tranexamic Acid for Reducing Perioperative Blood Loss During Revision Surgery for Vancouver Type B Periprosthetic Femoral Fractures After Total Hip Arthroplasty: A Retrospective Study

“…The optimal dosage, time points, and frequency of use of tranexamic acid remain to be explored. At the same time, it may be worthwhile investigating the efficacy and safety of oral, topical, or combined administration of tranexamic acid, which has been reported in primary hip arthroplasty. Oral and topical administration may be a safe alternative for patients with contraindications to intravenous administration.…”

Is combined topical and intravenous tranexamic acid superior to single use of tranexamic acid in total joint arthroplasty?

“…We created a “risk of bias” table that included the following elements: random sequence generation, allocation concealment, blinding, incomplete outcome data, free of selective reporting, and other bias. [ 6 , 7 ] The quality of the evidence for the main outcomes in present meta-analysis was evaluated using the Recommendations Assessment, Development and Evaluation (GRADE) system including the following items: risk of bias, inconsistency, indirectness, imprecision, and publication bias. The recommendation level of evidence is classified into the following categories: high, which means that further research is unlikely to change confidence in the effect estimate; moderate, which means that further research is likely to significantly change confidence in the effect estimate but may change the estimate; low, which means that further research is likely to significantly change confidence in the effect estimate and to change the estimate; and very low, which means that any effect estimate is uncertain.…”

Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial

“…In an attempt to make the results of this study useful in large academic settings and smaller community settings, the utilization of a pragmatic dosing scheme was used. There have been several studies that demonstrate that using this methodology reduces blood loss and transfusion rate in total joint arthroplasty [4,[6][7][8][9]. The comment regarding the biphasic nature of the fibrinolytic DOI of original article: http://dx.doi.org/10.1016/j.arth.2015.12.002.…”

Intravenous Tranexamic Acid for Reducing Perioperative Blood Loss During Revision Surgery for Vancouver Type B Periprosthetic Femoral Fractures After Total Hip Arthroplasty: A Retrospective Study

“…The optimal dosage, time points, and frequency of use of tranexamic acid remain to be explored. At the same time, it may be worthwhile investigating the efficacy and safety of oral, topical, or combined administration of tranexamic acid, which has been reported in primary hip arthroplasty. Oral and topical administration may be a safe alternative for patients with contraindications to intravenous administration.…”

Is combined topical and intravenous tranexamic acid superior to single use of tranexamic acid in total joint arthroplasty?

“…We created a “risk of bias” table that included the following elements: random sequence generation, allocation concealment, blinding, incomplete outcome data, free of selective reporting, and other bias. [ 6 , 7 ] The quality of the evidence for the main outcomes in present meta-analysis was evaluated using the Recommendations Assessment, Development and Evaluation (GRADE) system including the following items: risk of bias, inconsistency, indirectness, imprecision, and publication bias. The recommendation level of evidence is classified into the following categories: high, which means that further research is unlikely to change confidence in the effect estimate; moderate, which means that further research is likely to significantly change confidence in the effect estimate but may change the estimate; low, which means that further research is likely to significantly change confidence in the effect estimate and to change the estimate; and very low, which means that any effect estimate is uncertain.…”

Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial

“…In an attempt to make the results of this study useful in large academic settings and smaller community settings, the utilization of a pragmatic dosing scheme was used. There have been several studies that demonstrate that using this methodology reduces blood loss and transfusion rate in total joint arthroplasty [4,[6][7][8][9]. The comment regarding the biphasic nature of the fibrinolytic DOI of original article: http://dx.doi.org/10.1016/j.arth.2015.12.002.…”

Intravenous Tranexamic Acid for Reducing Perioperative Blood Loss During Revision Surgery for Vancouver Type B Periprosthetic Femoral Fractures After Total Hip Arthroplasty: A Retrospective Study

“…The optimal dosage, time points, and frequency of use of tranexamic acid remain to be explored. At the same time, it may be worthwhile investigating the efficacy and safety of oral, topical, or combined administration of tranexamic acid, which has been reported in primary hip arthroplasty. Oral and topical administration may be a safe alternative for patients with contraindications to intravenous administration.…”

Is combined topical and intravenous tranexamic acid superior to single use of tranexamic acid in total joint arthroplasty?

“…We created a “risk of bias” table that included the following elements: random sequence generation, allocation concealment, blinding, incomplete outcome data, free of selective reporting, and other bias. [ 6 , 7 ] The quality of the evidence for the main outcomes in present meta-analysis was evaluated using the Recommendations Assessment, Development and Evaluation (GRADE) system including the following items: risk of bias, inconsistency, indirectness, imprecision, and publication bias. The recommendation level of evidence is classified into the following categories: high, which means that further research is unlikely to change confidence in the effect estimate; moderate, which means that further research is likely to significantly change confidence in the effect estimate but may change the estimate; low, which means that further research is likely to significantly change confidence in the effect estimate and to change the estimate; and very low, which means that any effect estimate is uncertain.…”

Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial

“…In an attempt to make the results of this study useful in large academic settings and smaller community settings, the utilization of a pragmatic dosing scheme was used. There have been several studies that demonstrate that using this methodology reduces blood loss and transfusion rate in total joint arthroplasty [4,[6][7][8][9]. The comment regarding the biphasic nature of the fibrinolytic DOI of original article: http://dx.doi.org/10.1016/j.arth.2015.12.002.…”