Intravenous tranexamic acid use in revision total joint arthroplasty: a meta-analysis

Purpose: Massive perioperative blood loss in complex revision total joint arthroplasty (TJA) often requires blood transfusions. Tranexamic acid (TXA) has been used in elective primary TJA to minimize blood loss and transfusions. The purpose of this meta-analysis was to evaluate the safety and efficacy of intravenous TXA in revision TJA. Methods: A literature search of PubMed, Scopus, and the Cochrane Controlled Trials Register was performed to identify studies published between January 2000 and May 2017. All randomized controlled trials (RCTs) and retrospective cohort observational studies evaluating the efficacy of intravenous TXA during revision total knee arthroplasty (TKA) and total hip arthroplasty (THA) were included. The mean differences (MDs) of blood loss, hemoglobin (Hb) change, and red blood cell (RBC) units transfused were compiled, and ORs of transfusion and venous thromboembolism (VTE) events in TXA and control groups were calculated. Results: Seven studies involving 930 patients were included (501 TXA vs 429 control). Intravenous TXA use had a significantly less blood transfusion (OR=0.20, 95% CI=0.11-0.34, P<0.001), lower Hb drop (MD=-0.88, 95% CI=-1.31 to -0.44, P<0.001), and less number of RBC units transfused (MD=-0.44, 95% CI=-0.65 to -0.24, P<0.001) compared to control in the postoperative period. No significant difference was seen in blood loss (MD=-245, 95% CI=-556 to 66, P=0.12) and VTE events (OR=0.57, 95% CI=0.13-2.42, P=0.45) between groups. Conclusion: Our meta-analysis suggests that intravenous administration of TXA can significantly reduce blood transfusion requirements following revision TJA, without increasing the risk of VTE. However, due to the variation in included studies, larger RCTs are required to draw firm conclusions.