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Open Access Highly Accessed Research article

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

Rajiv Gandhi1*, Heather MK Evans2, Safiyyah R Mahomed3 and Nizar N Mahomed4

Author Affiliations

1 Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst St, 1-439 East Wing, Toronto, Ontario, Canada

2 University of Toronto, Toronto Western Hospital, 399 Bathurst St, 1-439 East Wing, Toronto, Ontario, Canada

3 MacMaster University, Toronto Western Hospital, 399 Bathurst St, 1-439 East Wing, Toronto, Ontario, Canada

4 Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst St, 1-439 East Wing, Toronto, Ontario, Canada

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BMC Research Notes 2013, 6:184  doi:10.1186/1756-0500-6-184

Published: 7 May 2013

Abstract

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receiving allogeneic blood transfusions, and/or incidence of thromboembolic complications; the study was a published or unpublished RCT from 1995 – July 2012.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.

Keywords:
Tranexamic acid; Antifibrinolytic; Allogeneic transfusions; Joint replacement