Meta-analysis for the efficacy and safety of tranexamic acid in total knee arthroplasty

doi:10.3969/j.issn.2095-4344.2015.09.026

Abstract

Abstract:

BACKGROUND: Increasing evidence has found that, tranexamic acid could reduce blood loss during total knee arthroplasty, but the efficacy and safety remain controversial. Whether tranexamic acid can reduce blood loss and increase the risk of thrombosis during the perioperative period, needs further systemic evaluation.
OBJECTIVE: To explore the safety and effectiveness of tranexamic acid in the total knee arthroplasty through a meta-analysis.
METHODS: Randomized controlled trials on tranexamic acid in total knee arthroplasty were retrieved from relevant databases. All retrieved documents and references were used as supplementary information. According to the inclusion and exclusion criteria, retrieved documents were screened and the quality was assessed, then meta-analyses were performed by using the RevMan 5.1 software. The mean difference of blood loss, the risk ratio of transfusion, and the incidence of deep vein thrombosis and pulmonary embolism in the tranexamic acid and control groups were calculated.
RESULTS AND CONCLUSION: Totally 17 randomized controlled studies were included. Meta-analysis results showed that, tranexamic acid significantly reduced the total blood loss [MD=-314.96, 95%CI(-448.76, -181.16)], postoperative blood loss [MD=-417.72, 95%CI(-508.87, -326.56)], and the proportion of patients requiring blood transfusion [RR=0.43, 95%CI(0.37, 0.51)], when compared with the control group. The incidence of deep vein thrombosis [RR=0.98, 95%CI(0.38, 2.52)] and pulmonary embolism showed no significant difference between the two groups. Tranexamic acid could reduce blood loss and blood transfusion for patients undergoing total knee arthroplasty, without increasing the risk of deep vein thrombosis and infection.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Arthroplasty, Replacement, Knee, Blood Loss, Surgical, Meta-analysis

CLC Number:

R318

Li Fei-xiong, Wang Zhi-yong, Zhang Zhi-qiang. Meta-analysis for the efficacy and safety of tranexamic acid in total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1463-1469.

Figures/Tables 5

References

[1] 赵旻暐,李子剑,张克. 氨甲环酸在人工全膝关节置换术中的应用[J].中华关节外科杂志(电子版),2014,8(2):236-239.
[2] Barwell J, Anderson G, Hassan A, et al. The effects of early tourniquet release during total knee arthroplasty: a prospective randomized double-blind study. J Bone Joint Surg [Br].1997;79:265-268.
[3] Kumar A. Perioperative management of anemia: limits of blood transfusion and alternatives to it. Cleve Clin J Med. 2009; 76:112-118.
[4] Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg [Br].2008;90: 1128-1136.
[5] Hill GE, Frawley WH, Griffith KE, et al. Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma Acute Care Surg. 2013;54(5):908-914.
[6] Rajesparan K, Biant LC, Ahmad M, et al. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg [Br]. 2009;91:776-783.
[7] Sukeik M, Alshryda S, Haddad FS,et al.Systematic review and meta -analysis of the use of tranexa mic acid in total hip replacement.J Bone Joint Surg Br.2011;93(1):39-46.
[8] 方志辉,杨华清,李兵奎,等. 氨甲环酸应用于膝关节置换术随机对照安慰剂试验的Meta分析[J].中华临床医师杂志(电子版), 2012,6(24):8173-8179.
[9] Panteli M, Papakostidis C, Dahabreh Z, et al. Topical tranexamic acidintotal knee replacement: Asystematic reviewandmeta-analysis. Knee. 2013;20(5):300-309.
[10] Ido K, Neo M, Asada Y, et al. Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties. Arch Orthop Trauma Surg. 2000;120:518-520
[11] Ellis MH, Fredman B, Zohar E, et al. The effect of tourniquet application, tranexamic acid, and desmopressin on the procoagulant and fibrinolytic systems during total knee replacement. J Clin Anesth. 2001;13:509-513.
[12] Engel JM, Hohaus T, Ruwoldt R, et al. Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or apro-tinin. Anesth Analg. 2001;92:775-780.
[13] Veien M, Sørensen JV, Madsen F, et al. Tranexamic acid given intraop-eratively reduces blood loss after total knee replacement: a randomized, controlled study. Acta Anaesthesiol Scand. 2002;46:1206-1211.
[14] Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90:596-599.
[15] Camarasa MA, Ollé G, Serra-Prat M, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth. 2006;96:576-582.
[16] Orpen NM, Little C, Walker G, et al. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised con-trolled trial of 29 patients. Knee. 2006;13:106-110.
[17] Alvarez JC, Santiveri FX, Ramos I, et al. Tranexamic acid reduces blood transfu-sion in total knee arthroplasty even when a blood conservation program is applied. Transfusion. 2008; 48:519-525.
[18] Kakar PN, Gupta N, Govil P, et al. Efficacy and safety of tranexamic acid in con-trol of bleeding following TKR: a randomized clinical trial. Indian J Anaesth. 2009;53: 667-671.
[19] Dhillon MS, Bali K, Prabhakar S. Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage. Indian J Orthop. 2011;45:148-152.
[20] Molloy DO, Archbold HA, Ogonda L, et al. Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial. J Bone Joint Surg Br. 2007;89(3):306-309.
[21] Charoencholvanich K, Siriwattanasakul P. Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospec-tive randomized controlled trial. Clin Orthop Relat Res. 2011;469 (10):2874-2880.
[22] Gautam PL, Katyal S, Yamin M, et al. Effect of tranexamic acid on blood loss and transfusion requirement in total knee re-placement in the Indian population: a case series. Indian J Anaesth. 2011;55(6):590-593.
[23] McConnell JS, Shewale S, Munro NA, et al. Reducing blood loss in primary knee arthroplasty: a prospective randomized controlled trial of tranexamic acid and fibrin spray. Knee. 2012; 19 (4):295-298.
[24] Chareancholvanich K, Siriwattanasakul P, Narkbunnam R, et al. Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2012;13:124.
[25] Lee SH, Cho KY, Khurana S, et al. Less blood loss under concomitant administration of tranexamic acid and indirect factor Xa inhibitor following total knee arthroplasty: a prospective ran-domized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2012.
[26] Lin PC, Hsu CH, Chen WS, et al. Does tranexamic acid save blood in minimally invasive total knee arthroplasty?Clin Orthop Relat Res. 2011;469:1995-2002.
[27] Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty:correct blood loss management should take hidden loss into account. Knee. 2000;7(3): 151-155.
[28] 高福强,李子剑,刘延青,等.初次全膝关节置换术后肢体肿胀程度与隐性失血量的相关性研究[J].中国矫形外科杂志,2011, 19(3): 199-202.
[29] Zhang H, Chen J, Chen F, et al. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2012;20(9):1742-1752.
[30] Ishida K, Tsumura N, Kitagawa A, et al. Intra -articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011;35(11):1639-1645.
[31] Camarasa MA, Olle G, Serra -Prat M, et al. Efficacy of aminocaproic，tranexamic acids inthe control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth. 2006;96(5):576-582.
[32] Orpen NM, Little C, Walker G, et al. Tranexamic acid reduces earlypost -operative blood loss after total knee arthroplasty: a prospective randomized controlled trial of 29 patients. Knee. 2006;13(2):106-110．
[33] Roy SP,Tanki UF,Dutta A,et al.Efficacy of intra-articular Tranexamic acid in blood loss reduction following primary unil ateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20(12): 2494-2501.
[34] Wong J, Abrishami A, El Beheiry H, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: arandomized，controlledtrial．J Bone Joint Surg Am. 2010;92(15):2503-2513.
[35] Alshryda S, Mason J, Vaghela M, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). J Bone Joint Surg Am. 2013;95(21): 1961-1968.
[36] Orpen NM, Little C, Walker G, et al. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee. 2006;13(2):106-110.
[37] 王思群,黄钢勇,夏军,等.全膝关节置换术后膝关节位置对术后失血的影响[J].中华关节外科杂志:电子版,2011,5(2): 19-21.
[38] 岳辰,马俊,杨沛青,等.氨甲环酸减少同期双侧全髋置换围术期失血有效性及安全性研究[J].中国矫形外科杂志, 2014,22(10)：865-869.
[39] Endo Y, Nishimura S, Miura A. Deep-vein thrombosis induced by tranexamic acid in idiopathic thrombocytopenic purpura. JAMA.1988;259(24):3561-3562.
[40] 尹勇,马广文,黄斐,等.氨甲环酸减少全髋关节置换失血量的Meta分析[J].中国组织工程研究.2014,18(17):2752-2757.
[41] Benoni G, Lethagen S, Fredin H.The effect of tranexamicacidon local and plasma fibrinolysis during total knee arthroplasty. Thromb Res. 1997;85:195-206.
[42] Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis．J Bone Joint Surg Am. 2012;94: 1153-1159．