Tranexamic acid in total knee replacement

Abstract

We conducted a systematic review and meta-analysis of randomised controlled trials evaluating the effect of tranexamic acid (TXA) upon blood loss and transfusion in primary total knee replacement. The review used the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. A total of 19 trials were eligible: 18 used intravenous administration, one also evaluated oral dosing and one trial evaluated topical use. TXA led to a significant reduction in the proportion of patients requiring blood transfusion (risk ratio (RR) 2.56, 95% confidence interval (CI) 2.1 to 3.1, p < 0.001; heterogeneity I(2) = 75%; 14 trials, 824 patients). Using TXA also reduced total blood loss by a mean of 591 ml (95% CI 536 to 647, p < 0.001; I(2) = 78%; nine trials, 763 patients). The clinical interpretation of these findings is limited by substantial heterogeneity. However, subgroup analysis of high-dose (> 4 g) TXA showed a plausible consistent reduction in blood transfusion requirements (RR 5.33; 95% CI 2.44 to 11.65, p < 0.001; I(2) = 0%), a finding that should be confirmed by a further well-designed trial. The current evidence from trials does not support an increased risk of deep-vein thrombosis (13 trials, 801 patients) or pulmonary embolism (18 trials, 971 patients) due to TXA administration.

Minimally Invasive Midvastus versus Standard Parapatellar Approach in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

“…However, the small surgical field and the increasing operative difficulty limit the popularity theses two approach [7], [8]. As a compromise of these approaches, mini-midvastus approach was introduced as it minimized the vascular and muscular disruption of knee and provided a relatively better operative exposure [6], [9]. Therefore, mini-midvastus approach has probably been the most popular approach in MIS TKA [10].…”

Total Knee Arthroplasty?; Post Operative Mean Blood Loss With Tranexamic Acid, Is Tranexamic Acid Effective in Reducing Blood Loss. A Randomized Controlled Trial in Tertiary Care Hospital, Pakistan

“…14 Alshryda S et all found that the evidence from trials does not support an increased risk of deepvein thrombosis or pulmonary embolism due to TXA administration. 16 Ishida et all did similar study but the significant findings beyond the reduction in blood loss after knee arthroplasty is the reduction in knee swelling,which are often the chief complaint in follow up of patients after knee arthroplasty. Sa-ngasoongsong P et all did another strategy, they beside the use of tranexamic acid also did clamping of drain and found more favourable results as compared to using tranexamic acid alone or clamping of drain without using this drug.…”

Tranexamic acid: a clinical review

“…Moreover, its efficacy and safety profile in orthopedic surgery is further supported by two meta-analyses of TXA use in primary hip [58] and knee [59] arthoplasty. In hip surgery, Sukeik et al [58] found that TXA reduced intraoperative blood loss by 104 mL and postoperative blood loss by 172 mL (n = 350).…”

“…There was also a proportional reduction of patients requiring blood transfusion (risk difference −0.20). In total knee replacement, Alshryda et al [59] found significant reduction in blood loss by 591 mL (n = 763). It should be noted that there was significant heterogeneity in the trials.…”

“…There is currently no clinical evidence that the use of TXA increases the risk of thromboembolic events, namely myocardial infarction, stroke, deep vein thrombosis or pulmonary embolism according to meta-analyses and clinical trials cited in the general [22,63], trauma [82], orthopedic [48,56,58,59,78], cardiac [25,32,153] or obstetric & gynecological [111,112,119,123] settings. However, there are reports of catastrophic intracardiac or intrapulmonary thromboses [154], whose putative cause was antifibrinolytic use, albeit none involved TXA.…”