The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: Combined tranexamic acid for TKA

Abstract

Objectives: Tranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA.

Materials and methods: A systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software.

Results: A total of ten RCTs (1143 patients) were included in this study. All the included studies were randomised and the quality of included studies still needed improvement. The results indicated that, compared with either placebo or the single-dose TXA (IV or IA) group, the combination of IV and IA TXA group had significantly less total blood loss, hidden blood loss, total drain output, a lower transfusion rate and a lower drop in haemoglobin level. There were no statistically significant differences in complications such as wound infection and deep vein thrombosis between the combination group and the placebo or single-dose TXA group.

Conclusions: Compared with placebo or the single-dose TXA, the combined use of IV and IA TXA provided significantly better results with respect to all outcomes related to post-operative blood loss without increasing the risk of thromboembolic complications in TKA.Cite this article: Z. F. Yuan, H. Yin, W. P. Ma, D. L. Xing. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: combined tranexamic acid for TKA. Bone Joint Res 2016;5:353-361. DOI: 10.1302/2046-3758.58.BJR-2016-0001.R2.

Keywords: Combination; Total knee arthroplasty; Tranexamic acid.

Fig. 1

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of study screening and exclusions

Fig. 2

Forest plot of combination of intravenous and intra-articular tranexamic acid versus placebo in blood loss.

Fig. 3

Forest plot of combination of intravenous and intra-articular tranexamic acid versus placebo in transfusion rates.

Fig. 4

Forest plot of combination of intravenous and intra-articular tranexamic acid versus placebo in Hb drop.

Fig. 5

Forest plot of combination of intravenous and intra-articular tranexamic acid versus placebo in deep vein thrombosis.

Fig. 6

Forest plot of combination versus single tranexamic acid in blood loss.

Fig. 7

Forest plot of combination versus single tranexamic acid in transfusion rates.

Fig. 8

Forest plot of combination versus single tranexamic acid in Hb drop.

Fig. 9

Forest plot of combination versus single tranexamic acid in length of hospital stay.

Fig. 10

Forest plot of combination versus single tranexamic acid in complications.