Intravenous infusion versus local application of tranexamic acid in primary unilateral total hip arthroplasty: a meta-analysis

doi:10.3969/j.issn.2095-4344.1265

Abstract

Abstract:

BACKGROUND: The effect of tranexamic acid on hemostasis in total hip arthroplasty has been recognized by more and more scholars. However, its safe and effective application still remains controversial.

OBJECTIVE: To compare the efficacy about intravenous infusion and topical application concerning tranexamic acid in the primary unilateral total hip arthroplasty.

METHODS: Cochrane Library, PubMed, Embase, CNKI and WanFang databases were retrieved for the articles published before November 2018. For discovering all the required literature, all relevant papers and references in the included literature were consulted. All the papers included were strictly assessed by selection as well as exclusion criteria, in order to evaluate their conformity with the project and their quality. Finally, a meta-analysis of eligible studies was conducted.

RESULTS AND CONCLUSION: (1) Nine eligible studies were included (improved Jadad score ≥ 4 points) discussed by 3 researchers. (2) This study showed that intravenous infusion had an advantage over local application [WMD=-4.08, 95%CI (-5.99, -2.17), P < 0.01] on the effect of tranexamic acid reducing the postoperative change of hemoglobin. (2) No significant difference occurred between intravenous infusion and local application in total perioperative blood loss [WMD=-26.10, 95%CI (-56.96, 4.76), P=0.10], transfusion rate [RR=0.92, 95%CI (0.62, 1.35), P=0.66], postoperative risk of deep venous thrombosis in lower extremities [RR=1.26, 95%CI (0.34, 4.65), P=0.72], postoperative risk of pulmonary embolism [RR=2.96, 95%CI (0.12, 71.38), P=0.50] and postoperative incidence of incision complications [RR=0.78, 95%CI (0.40, 1.52), P=0.47]. (4) In summary, tranexamic acid with intravenous infusion can reduce perioperative hemoglobin changes, with no increase in postoperative risk of deep venous thrombosis in lower extremities, pulmonary embolism and poor incision healing. As a result, tranexamic acid in intravenous infusion is recommended when primary unilateral hip arthroplasty is conducted.

Key words: unilateral hip arthroplasty, tranexamic acid, intravenous infusion, topical application, blood loss, transfusion rate, deep venous thrombosis, meta-analysis

CLC Number:

R459.9

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R459.9

Lu Zhan, Shi Junlong, Liu Peidong, Lei Hongwei, Yang Ziquan.

Intravenous infusion versus local application of tranexamic acid in primary unilateral total hip arthroplasty: a meta-analysis

[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(24): 3931-3936.

Figures/Tables 3

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