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Systematic review and meta-analysis of intravenous and topical tranexamic acid in reducing blood loss in knee arthroplasty

Jaroslaw Pecold12, Mahdi Al-Jeabory12, Michal Matuszewski3, Michal Pruc1, Anatoliy Maslyukov4, Maciej Krupowies2, Ewa Manka5, Jacek Smereka16, Lukasz Szarpak178
DOI: 10.5603/DEMJ.a2022.0025
Affiliations
  1. Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
  2. Department of Trauma and Orthopedic Surgery, Ruda Slaska City Hospital, Ruda Slaska, Poland
  3. Department of Anaesthesiology and Intensive Therapy at the Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
  4. Department of Biomedical Sciences, Odessa International Medical University, Odessa, Ukraine
  5. Department of Internal Medicine, Angiology and Physical Medicine in Bytom, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
  6. Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
  7. Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
  8. Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland

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ORIGINAL ARTICLES
Published online: 2022-06-28

Abstract

INTRODUCTION: The purpose of this review and meta-analysis is to compare tranexamic acid (TXA) administration via the intravenous route (IV-TXA) and topical route (T-TXA), in reducing blood loss in knee arthroplasty.

MATERIAL AND METHODS: A systematic literature search was performed using Medline, EMBASE, Scopus and CENTRAL databases till December 20, 2021. Outcomes of interest included blood loss, hematocrit and hemoglobin drop, and adverse events.

RESULTS: A total of 3,363 patients (n = 1,307 in IV-TXA group; n = 2,056 in T-TXA group) from 23 studies were included. There was no statistically significantly difference between IV-TXA and T-TXA among to: total blood loss (874.8 ± 349.7 mL vs 844.9 ± 366.6 ml, respectively; SMD = 0.13; 95% CI: −9.37 to 85.32; p = 0.15), as well as transfusion needed (10.9% vs 15.4% respectively (RR = 0.79; 95% CI: 0.60 to 1.04; p = 0.09). Blood loss from the drain in IV-TXA and T-TXA varied and occurred 377.9 ± 191.9 vs 302.9 ± 182.6 mL for IV-TXA and T-TXA, respectively: (SMD = 0.52; 95% CI: 0.02 to 1.02; p = 0.04).

CONCLUSIONS: Our clinical findings support that TXA can effectively, safely, and decrease the number of transfusions without severe side effects in patients undergoing TKA. However, given the reports from individual single clinical trials of the superiority of T-TXA, further clinical trials and meta-analyses based on these findings are needed to standardize the approach to TXA use in patients undergoing knee arthroplasty.

Abstract

INTRODUCTION: The purpose of this review and meta-analysis is to compare tranexamic acid (TXA) administration via the intravenous route (IV-TXA) and topical route (T-TXA), in reducing blood loss in knee arthroplasty.

MATERIAL AND METHODS: A systematic literature search was performed using Medline, EMBASE, Scopus and CENTRAL databases till December 20, 2021. Outcomes of interest included blood loss, hematocrit and hemoglobin drop, and adverse events.

RESULTS: A total of 3,363 patients (n = 1,307 in IV-TXA group; n = 2,056 in T-TXA group) from 23 studies were included. There was no statistically significantly difference between IV-TXA and T-TXA among to: total blood loss (874.8 ± 349.7 mL vs 844.9 ± 366.6 ml, respectively; SMD = 0.13; 95% CI: −9.37 to 85.32; p = 0.15), as well as transfusion needed (10.9% vs 15.4% respectively (RR = 0.79; 95% CI: 0.60 to 1.04; p = 0.09). Blood loss from the drain in IV-TXA and T-TXA varied and occurred 377.9 ± 191.9 vs 302.9 ± 182.6 mL for IV-TXA and T-TXA, respectively: (SMD = 0.52; 95% CI: 0.02 to 1.02; p = 0.04).

CONCLUSIONS: Our clinical findings support that TXA can effectively, safely, and decrease the number of transfusions without severe side effects in patients undergoing TKA. However, given the reports from individual single clinical trials of the superiority of T-TXA, further clinical trials and meta-analyses based on these findings are needed to standardize the approach to TXA use in patients undergoing knee arthroplasty.

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Keywords

arthroplasty; knee; replacement; tranexamic acid; intravenous; topical; systematic review; meta-analysis

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Title

Systematic review and meta-analysis of intravenous and topical tranexamic acid in reducing blood loss in knee arthroplasty

Journal

Disaster and Emergency Medicine Journal

Issue

Ahead of Print

Article type

Research paper

Published online

2022-06-28

Page views

48

Article views/downloads

32

DOI

10.5603/DEMJ.a2022.0025

Keywords

arthroplasty
knee
replacement
tranexamic acid
intravenous
topical
systematic review
meta-analysis

Authors

Jaroslaw Pecold
Mahdi Al-Jeabory
Michal Matuszewski
Michal Pruc
Anatoliy Maslyukov
Maciej Krupowies
Ewa Manka
Jacek Smereka
Lukasz Szarpak

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