Clinical Outcomes Following Use of Tranexamic Acid in High Tibial Osteotomy: A Systematic Review.

Abstract

This study aimed to evaluate the clinical outcomes following administration of tranexamic acid (TXA) in patients undergoing hightibial osteotomy (HTO) through a systematic review of current available evidence. A systematic database search of PubMed, Embaseand Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed from inception up to December 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Inclusion criteria were (i) randomised control trials, cohort studies or case-control studies that had more than 10 patients; (ii) studies reporting outcomes after TXA administration, of any route, before or after HTO, compared toplacebo, controland different doses or routes; and (iii) studies reporting blood loss, including haemoglobin (Hb) drop, estimated blood loss, transfusion requirementand complications. Case reports, reviews, abstracts, non-HTO studies, non-human studiesand duplicates were excluded. A synthesized comparison of drain output, wound complications, transfusion requirementand pooled analyses of blood loss and Hb dropwas performed. Eleven studies involving 974 patients were included. Nine studies had placebo comparison, and two used single-dose TXA versus multiple doses. All studies reported on postoperative hemoglobin and nine on blood loss. In the six TXA versus placebo studies reporting on total blood loss, the TXA group had a pooled, estimated standardised mean difference (SMD) in blood loss of -2.37 (95% confidence interval (CI) -3.67, -1.07; P = 0.0004). For the Hb drop, on postoperative days (PODs) one, two, and five, the SMDs were-0.97 (95% CI -1.19, -0.75; P < 0.00001) for POD1, -0.74 (95% CI -1.03, -0.46; P < 0.00001) for POD2and -0.87 (95% CI -1.10, -0.64; P < 0.00001) for POD5. TXA administration in HTO significantly reduces perioperative blood loss. This can greatly improve recovery, reduce complicationsand shortenlength of stay. This is especially pertinent given supply shortages of NHS blood resources.