Combined tranexamic acid and diluted epinephrine reduces blood loss following primary total knee arthroplasty

Abstract

Objective To evaluate the effect and safety of combination of tranexamic acid (TXA) and diluted-epinephrine (DEP) on blood loss during the primary total knee arthroplasty (TKA). Methods The electronic databases of PubMed, Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials, Web of Science, Wanfang and China National Knowledge Infrastructure (CNKI) were searched. TXA+ DEP were initially searched of the high-quality randomized controlled trials (RCTs) in TKA by the inclusion criteria, the intervention measures were as follows: the experimental group was TXA DEP, the control group was TXA. Meta-analysis was performed using RevMan 5.2 software. Results A total of six RCTs were included. The results of meta analysis showed that using TXA+ DEP could reduce the average total blood loss [MD =-184.32, 95%CI(-251.11, -117.52), P<0.01], reduce the average amount of hidden blood loss [MD =-150.89, 95%CI(-179.83, -121.95), P<0.00001], and reduce the average amount of drainage [MD =-63.16, 95%CI(-116.29, -10.02), P=0.02]. The combination application of TXA+ DEP could significantly reduce the blood transfusion rate [RR =0.51, 95%CI(0.28, 0.93), P=0. 03]. There was no significant difference in the incidence of DVT between the two groups (P=1.00). Conclusion Combination application of TXA+ DEP can effectively reduce the blood loss and transfusion rate in primary TKA, without increasing the incidence of DVT. Key words: Tranexamic acid; Epinephrine; Arthroplasty, replacement, knee; Meta-analysis