Use of Intravenous Tranexamic Acid to Reduce Allogeneic Blood Transfusion in Total Hip and Knee Arthroplasty: A Meta-analysis

Abstract

Total hip or knee arthroplasty is associated with significant blood loss. Techniques such as the use of antifibrinolytics or desmopressin, or normovolaemic haemodilution have been used to reduce the need for allogeneic blood transfusion. Tranexamic acid has been used to reduce blood loss and transfusion requirement for total hip and knee arthroplasty, with variable results. This meta-analysis aims to evaluate whether intravenous tranexamic acid, when compared with placebo, reduces blood loss and transfusion requirement in total hip and knee joint replacement surgery and whether it might increase the risk of thromboembolic complications. The literature search was based on MEDLINE, EMBASE, Cochrane Controlled Trials Register, and information from the pharmaceutical company that produces tranexamic acid (Pharmacia-Upjohn). We identified 15 clinical trials and 12 were considered suitable for detailed data extraction. Tranexamic acid reduces the proportion of patients requiring allogeneic blood transfusion (OR 0.16, 95% CI: 0.09-0.26), total amount of blood loss (WMD 460 ml, 95% CI: 274-626 ml), and the total number of units of allogeneic blood transfused (WMD 0.85 unit, 95% CI: 0.36-1.33). Tranexamic acid does not increase the risk of thromboemobolic complications such as deep vein thrombosis, pulmonary embolism, thrombotic cerebral vascular accident, or myocardial infarction (OR 0.98, 95% CI: 0.45-2.12). Intravenous tranexamic acid appears effective and safe in reducing allogeneic blood transfusion and blood loss in total hip and knee arthroplasty.

Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery

“…Various antifibrinolytic agents have been used with success in cardiac surgery [2,3], obstetrics [4], upper gastrointestinal haemorrhage [4], liver transplant [5], and other major orthopaedics surgeries with potential for increased blood loss [6][7][8]. However, with regards to the efficacy of these agents, there is evidence to the contrary as well.…”

“…Antifibrinolytic agents, such as aprotinin and tranexamic acid, have been shown to reduce blood loss in orthopaedic and other surgical procedures [2][3][4][5][6][7][8][9][10][11]. The primary aim of this study was to compare the effect of aprotinin and tranexamic acid in adult scoliosis correction surgery.…”

Prerequisites of a functional haemostasis

“…In der bereits erwähnten Studie von Ferrara et al hatten Nichtüberlebende einen niedrigeren pH-Wert (pH 7,04±0,06 vs. 7,18±0,02, p<0,05) [21]. Eine Abnahme des pH-Werts von 7,4 auf 7,0 reduziert die Aktivität des Enzymkomplexes, der Thrombin aktiviert, um mehr als 70% [38]. Eine gleiche Senkung des pH-Werts reduzierte die Aktivität von FVIIa über 90% und von FVIIa/TF über 60% [63].…”

Möglichkeiten der lokalen und systemischen Blutstillung bei chirurgischen Eingriffen

“…Diese Effekte der Anwendung von Lysinanaloga wurden nicht nur in der orthopädischen Chirurgie beobachtet [11]: Eine randomisierte kontrollierte Doppelblindstudie an 108 Patienten erbrachte den Nachweis, dass die systemische perioperative Applikation von Tranexamsäure bei elektiven Leberresektionen den intraoperativen Blutverlust und die Rate von Bluttransfusionen signifikant senkt [30].…”