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. 2024 Jun 3;9(6):467-478.
doi: 10.1530/EOR-23-0140.

Tranexamic acid may benefit patients with preexisting thromboembolic risk undergoing total joint arthroplasty: a systematic review and meta-analysis

Xiangji Dang  1   2 , Mei Liu  3 , Qiang Yang  4 , Jin Jiang  5 , Yan Liu  6 , Hui Sun  7 , Jinhui Tian  1
Affiliations

Tranexamic acid may benefit patients with preexisting thromboembolic risk undergoing total joint arthroplasty: a systematic review and meta-analysis

Xiangji Dang et al. EFORT Open Rev. .

Abstract

Purpose: This study sought to determine if the use of tranexamic acid (TXA) in preexisting thromboembolic risk patients undergoing total joint arthroplasty (TJA) was linked to an increased risk of death or postoperative complications.

Methods: We conducted a comprehensive search for studies up to May 2023 in PubMed, Web of Science, EMBASE, and the Cochrane Library. We included randomized clinical trials, cohort studies, and case-control studies examining the use of TXA during TJA surgeries on high-risk patients. The Cochrane Risk of Bias instrument was used to gauge the excellence of RCTs, while the MINORS index was implemented to evaluate cohort studies. We used mean difference (MD) and relative risk (RR) as effect size indices for continuous and binary data, respectively, along with 95% CIs.

Results: Our comprehensive study, incorporating data from 11 diverse studies involving 812 993 patients, conducted a meta-analysis demonstrating significant positive outcomes associated with TXA administration. The findings revealed substantial reductions in critical parameters, including overall blood loss (MD = -237.33; 95% CI (-425.44, -49.23)), transfusion rates (RR = 0.45; 95% CI (0.34, 0.60)), and 90-day unplanned readmission rates (RR = 0.86; 95% CI (0.76, 0.97)). Moreover, TXA administration exhibited a protective effect against adverse events, showing decreased risks of pulmonary embolism (RR = 0.73; 95% CI (0.61, 0.87)), myocardial infarction (RR = 0.47; 95% CI (0.40-0.56)), and stroke (RR = 0.73; 95% CI (0.59-0.90)). Importantly, no increased risk was observed for mortality (RR = 0.53; 95% CI (0.24, 1.13)), deep vein thrombosis (RR = 0.69; 95% CI (0.44, 1.09)), or any of the evaluated complications associated with TXA use.

Conclusion: The results of this study indicate that the use of TXA in TJA patients with preexisting thromboembolic risk does not exacerbate complications, including reducing mortality, deep vein thrombosis, and pulmonary embolism. Existing evidence strongly supports the potential benefits of TXA in TJA patients with thromboembolic risk, including lowering blood loss, transfusion, and readmission rates.

Keywords: systematic review; total hip arthroplasty (THA); total joint arthroplasty (TJA); total knee arthroplasty (TKA); tranexamic acid; venous thromboembolic event.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the study reported.

Figures

Figure 1
Figure 1
The flowchart of literature screening.
Figure 2
Figure 2
Association between TXA use and total blood loss (11, 12, 18, 20).
Figure 3
Figure 3
Association between TXA use and transfusion rates (11, 12, 13, 16, 18, 19, 20, 21).
Figure 4
Figure 4
Association between TXA use and 90-day unplanned readmission (11, 13, 15, 16).
Figure 5
Figure 5
Association between TXA use and mortality (11, 12, 13, 14, 15).
Figure 6
Figure 6
Association between TXA use and deep vein thrombosis (12, 13, 14, 15, 16, 19, 21).
Figure 7
Figure 7
Association between TXA use and pulmonary embolism (12, 13, 14, 15, 16, 19).
Figure 8
Figure 8
Association between TXA use and myocardial infarction (11, 13, 14, 15, 19).
Figure 9
Figure 9
Association between TXA use and stroke (11, 13, 14, 15, 19).
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