One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration

• Published in: Archives of orthopaedic and trauma surgery Vol. 135; no. 4; pp. 573 - 588
• Main Authors: Shemshaki, Hamidreza, Nourian, Sayed Mohammad Amin, Nourian, Niloofaralsadat, Dehghani, Masoudhatef, Mokhtari, Masoud, Mazoochian, Farhad
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2015; Springer Nature B.V
• Subjects: Antifibrinolytic agents; Antifibrinolytic Agents - administration & dosage; Arthroplasty, Replacement, Knee - adverse effects; Blood Loss, Surgical - prevention & control; Blood Loss, Surgical - statistics & numerical data; Blood Transfusion - utilization; Health risk assessment; Humans; Infusions, Intravenous; Joint surgery; Knee Arthroplasty; Medicine; Medicine & Public Health; Meta-analysis; Orthopedics; Systematic review; Thromboembolism; Tranexamic Acid - administration & dosage; Tranexamic acid; Total knee arthroplasty; Intraarticular; Intravenous; Meta-analysis
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-015-2189-7

Background
Tranexamic acid (TXA) in orthopedics has recently been gaining favor due to its efficacy and ease of use, both in intravenous (IV) and intraarticular (IA) usage. However, because of safety concerns with IV administration, there has been a growing interest in the IA use of TXA to prevent bleeding.
Materials and methods
This study conducted a systematic review and meta-analysis that included 31 randomized, controlled trials in which the effect of systemic and topical TXA on total blood loss (TBL), rates of transfusion, and thromboembolic events was investigated.
Results
Compared to the control, the IA administration of TXA led to the significant reduction of mean TBL (
p
 < 0.001), rate of transfusion (
p
 < 0.001), and reduction of rate of thromboembolic events (
p
 = 0.29). Compared to the control group, the IV administration of TXA resulted in significant reduction of mean TBL (
p
 < 0.001), rate of transfusion (
p
 < 0.001), and rate of thromboembolic events (
p
 = 0.66). Although no significant differences in efficacy and safety between the IA and IV administration of TXA were found, the IA method was safer than the IV method in that it reduced rate of transfusion and thromboembolic events.
Conclusion
This study showed that TXA leads to significant reductions in TBL and the rate of allogeneic transfusions. Generally, no significant difference was detected between IA and IV administration of TXA; however, more studies with focus on safety and efficacy are warranted.