A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty

Abstract

Background: To evaluate the effectiveness and safety of tranexamic acid (TEA) treatment in reducing perioperative blood loss and transfusion for patients receiving primary unilateral total knee arthroplasty (TKA) and to explore the most effective and safe protocol.

Materials and methods: This study was based on Cochrane methodology for conducting meta-analyses. Only randomized controlled trials were eligible for this study. The participants were adults who had undergone primary unilateral TKA. The Review Manager Database (RevMan version 5.0, The Cochrane Collaboration, 2008) was used to analyze selected studies.

Results: Nineteen randomized controlled trials involving 1114 patients were included. The use of TEA reduced postoperative drainage by a mean of 290 mL (95% confidence interval [CI] -385 to -196], total blood loss by a mean of 570 mL (95% CI -663 to -478), the number of blood transfusions per patient by 0.96 units (95% CI -1.32 to -0.59), and the volumes of blood transfusions per patient -440 mL (95% CI -518 to -362). TEA led to a significant reduction in the proportion of patients requiring blood transfusion (relative risk 0.39). There were no significant differences in venous thromboembolism or other adverse events among the study groups.

Conclusions: Intravenous TEA could significantly reduce perioperative blood loss and blood transfusion requirements following primary unilateral TKA. Its application is not associated with increased risk of venous thromboembolisms or other adverse events.

Keywords: Arthroplasty; Meta-analysis; Total knee; Tranexamic acid.