Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: A meta-analysis

被引：136
作者：
Gandhi R. [1 ]
Evans H.M.K. [2 ]
Mahomed S.R. [3 ]
Mahomed N.N. [1 ]
机构：
[1] Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, 399 Bathurst St
[2] University of Toronto, Toronto Western Hospital, Toronto, ON, 399 Bathurst St
[3] MacMaster University, Toronto Western Hospital, Toronto, ON, 399 Bathurst St
来源：
BMC Research Notes | / 6卷 / 1期
关键词：
Allogeneic transfusions; Antifibrinolytic; Joint replacement; Tranexamic acid;
D O I：
10.1186/1756-0500-6-184
中图分类号：
学科分类号：
摘要：
Background: Tranexamic acid (TXA) is an antifibrinolytic drug used as a blood-sparing technique in many surgical specialties. The principal objective of our meta-analysis was to review randomized, controlled trials (RCT) comparing total blood loss and the number of patients receiving allogeneic blood transfusions with and without the use of TXA for knee (TKA) and hip (THA) arthroplasty. Methods. Studies were included if patients underwent primary unilateral TKA or THA; the study involved the comparison of a TXA treatment group to a control group who received either a placebo or no treatment at all; outcome measures included total blood loss TBL, number of patients receiving allogeneic blood transfusions, and/or incidence of thromboembolic complications; the study was a published or unpublished RCT from 1995 - July 2012. Results: Data were tested for publication bias and statistical heterogeneity. Combined weighted mean differences in blood loss favoured TXA over control for TKA and THA patients respectively [ -1.149 (p < 0.001; 95% CI -1.298, -1.000), -0.504 (p < 0.001; 95% CI, -0.672, -0.336)]. Combined odds ratios favoured fewer patients requiring allogeneic transfusions for TKA and THA with the use of TXA respectively [0.145 (p < 0.001; 95% CI, 0.094, 0.223), 0.327 (p < 0.001; 95% CI, 0.208, 0.515)]. Combined odds ratios indicated no increased incidence of DVT with TXA use in TKA and THA respectively [1.030 (p = 0.946; 95% CI, 0.439, 2.420), 1.070 (p = 0.895; 95% CI, 0.393, 2.911)]. Conclusions: TXA should be considered for routine use in primary knee and hip arthroplasty to decrease blood loss. © 2013 Gandhi et al.; licensee BioMed Central Ltd.
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  • [11] Wong J., Abrishami A., El Beheiry H., Mahomed N.N., Roderick Davey J., Gandhi R., Syed K.A., Muhammad Ovais Hasan S., De Silva Y., Chung F., Topical application of tranexamic acid reduces postoperative blood loss in total knee Arthroplasty: A randomized, double-blinded, placebo-controlled trial of efficacy, J Bone Joint Surg Am, 92, pp. 2503-2513, (2010)
  • [12] Hiippala S.T., Strid L.J., Wennerstrand M.I., Arvela J.V.V., Niemela H.M., Mantyla S.K., Kuisma R.P., Ylinen J.E., Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty, Anesthesia and Analgesia, 84, 4, pp. 839-844, (1997)
  • [13] Ortega-Andreu M., Perez-Chrzanowska H., Figueredo R., Gomez-Barrena E., Blood loss control with two doses of tranexamic acid in a multimodal protocol for total knee Arthroplasty, Open Orthop J, 5, pp. 44-48, (2011)
  • [14] Garneti N., Field J., Bone bleeding during total hip arthroplasty after administration of tranexamic acid, Journal of Arthroplasty, 19, 4, pp. 488-492, (2004)
  • [15] Ralley F.E., Berta D., Binns V., Howard J., Naudie D.D.R., One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty, Clin Orthop Relat Res, 468, pp. 1905-1911, (2010)
  • [16] MacGillivray R.G., Tarabichi S.B., Hawari M.F., Raoof N.T., Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty, a prospective, randomized double blind study, J Arthroplasty, 26, pp. 24-28, (2011)
  • [17] Benoni G., Fredin H., Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: A prospective, randomised, double-blind study of 86 patients, Journal of Bone and Joint Surgery - Series B, 78, 3, pp. 434-440, (1996)
  • [18] Good L., Peterson E., Lisander B., Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement, British Journal of Anaesthesia, 90, 5, pp. 596-599, (2003)
  • [19] Molloy D.O., Archbold H.A.P., Ogonda L., McConway J., Wilson R.K., Beverland D.E., Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: A prospective, randomised controlled trial, Journal of Bone and Joint Surgery - Series B, 89, 3, pp. 306-309, (2007)
  • [20] Malhotra R., Kumar V., Garg B., The use of tranexamic acid to reduce blood loss in primary cementless total hip arthroplasty, Eur J Orthop Surg, 21, pp. 101-104, (2011)
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