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Meta-Analysis
. 2016 Dec;95(50):e5583.
doi: 10.1097/MD.0000000000005583.

Comparing efficacy and safety of 2 methods of tranexamic acid administration in reducing blood loss following total knee arthroplasty: A meta-analysis

Yu Fu  1 , Zhigang Shi, Bing Han, Yong Ye, Tao You, Juehua Jing, Jun Li
Affiliations
Meta-Analysis

Comparing efficacy and safety of 2 methods of tranexamic acid administration in reducing blood loss following total knee arthroplasty: A meta-analysis

Yu Fu et al. Medicine (Baltimore). 2016 Dec.

Abstract

Background: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) were to gather data to evaluate the efficacy and safety of topical tranexamic acid (TXA) versus intravenous (IV) TXA for blood loss after a total knee arthroplasty (TKA).

Methods: Electronic databases: Pubmed, Web of Science, Cochrane library, and Embase from inception to June 2016 were searched. RCTs that comparing topical with IV TXA for blood loss control in patients prepared for TKA were included in this meta-analysis. The Cochrane risk of bias tool was used to appraise risk of bias. The primary outcomes were needed for transfusion, total blood loss, and blood loss in drainage. Secondary outcomes are hemoglobin (Hb) value at 24-hour post TKA and complication (deep venous thrombosis [DVT] and infection). The efficacy of blood loss was tested by total blood loss, drainage volume, Hb drop, and the Hb value at 24 hours after TKA. The safety was measured by the occurrence of DVT and infection. Continuous outcomes were expressed as the mean difference with the respective 95% confidence intervals (CIs). Discontinuous outcomes were expressed as the relative risk with 95% CIs. Stata 12.0 software (Stata Corp., College Station, TX) was used for the meta-analysis.

Results: A total of 14 articles involving 1390 patients were finally included for this meta-analysis. The pooled results revealed that there were no significant difference between the need for transfusion, total blood loss, blood loss in drainage, Hb value at 24-hour post TKA, the occurrence of complications (infection and DVT) between topical administration of TXA and IV TXA.

Conclusion: Topical TXA has similar efficacy for blood loss control to IV TXA without sacrificing safety in TKA. However, the dose of topical TXA and IV TXA is different, thus, optimal timing and dose of TXA are still needed to explore the maximum effect of TXA.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The flowchart of the included studies.
Figure 2
Figure 2
The risk of bias summary of the included studies.
Figure 3
Figure 3
The risk of bias graph of the included studies.
Figure 4
Figure 4
The funnel plot of the need for transfusion for intravenous tranexamic acid (TXA) versus topical TXA.
Figure 5
Figure 5
Begg test for need for transfusion.
Figure 6
Figure 6
Sensitivity analysis of the need for transfusion.
Figure 7
Figure 7
The funnel plot comparing total blood loss.
Figure 8
Figure 8
Sensitivity analysis for total blood loss.
Figure 9
Figure 9
The funnel plot comparing blood loss in drainage.
Figure 10
Figure 10
Sensitivity analysis for blood loss in drainage.
Figure 11
Figure 11
The funnel plot comparing hemoglobin drop.
Figure 12
Figure 12
Sensitivity analysis for hemoglobin drop.
Figure 13
Figure 13
Funnel plot comparing hemoglobin value at 24-hour post total knee arthroplasty between the 2 groups.
Figure 14
Figure 14
Funnel plot comparing the occurrence of infection.
Figure 15
Figure 15
Funnel plot comparing the occurrence of deep venous thrombosis.
See this image and copyright information in PMC

References

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