Abstract
BackgroundThe standard protocol to achieve haemostasis during total hip arthroplasty (THA) is uncertain. Tranexamic acid plus diluted epinephrine (DEP) and tranexamic acid (TXA) alone are the two most common alternatives. The purpose of this study was to compare the efficacy and safety of TXA plus DEP to treat blood loss in THA patients.MethodsPublished randomized controlled trials (RCTs) were identified from the following electronic databases: PubMed, Embase, Web of Science, Cochrane Library and Google from inception to July 10, 2018. Studies comparing TXA plus DEP with TXA alone to treat blood loss were included. Either a random-effects model or a fixed-effects model was used for meta-analysis depending on the heterogeneity. We used the need for transfusion as the primary outcome. Stata 12.0 was used for meta-analysis.ResultsSix studies involving 703 patients were included in the present meta-analysis. The pooled results demonstrated that TXA plus DEP was associated with a lower transfusion rate than TXA alone (RR = 0.57, 95% CI 0.38–0.86, P = 0.006). Furthermore, TXA plus DEP was associated with less total blood loss and hidden blood loss by approximately 209.79 ml and 297.74 ml, respectively, than TXA alone. There was no significant difference in terms of intraoperative blood loss or the occurrence of deep venous thrombosis or haematoma between the TXA plus DEP and TXA alone groups (P > 0.05).ConclusionsOur meta-analysis suggested that TXA plus DEP significantly decreased the need for transfusion, total blood loss and hidden blood loss among THA patients. Furthermore, TXA plus DEP did not increase the occurrence of DVT or haemostasis. Additional long-term follow-up RCTs are needed to identify the optimal doses of TXA and DEP.
Highlights
Total hip arthroplasty (THA) is an effective treatment for end-stage hip osteoarthritis (OA) [1]
The pooled results demonstrated that tranexamic acid (TXA) plus diluted epinephrine (DEP) was associated with a lower transfusion rate than TXA alone (RR = 0.57, 95% confidence intervals (CIs) 0.38–0.86, P = 0.006, Fig. 4)
The funnel plots were visually assessed and revealed no asymmetry (Fig. 11); no evidence of publication bias was determined by the Egger linear regression test for the need for transfusion (P = 0.72, Fig. 12), Discussion In the current meta-analysis, we evaluated the efficacy and safety of TXA plus DEP for patients with total hip arthroplasty (THA)
Summary
Total hip arthroplasty (THA) is an effective treatment for end-stage hip osteoarthritis (OA) [1]. Blood transfusion carries the risk of hepatitis virus transmission and Several alternatives are available for minimizing blood loss after THA. These include topical fibrin sealants, topical or intravenous tranexamic acid (TXA) [7, 8], aminocaproic acid [3, 9] or diluted epinephrine (DEP) [10]. Administration TXA plus DEP has become popular for THA patients [11]. Tranexamic acid plus diluted epinephrine (DEP) and tranexamic acid (TXA) alone are the two most common alternatives. The purpose of this study was to compare the efficacy and safety of TXA plus DEP to treat blood loss in THA patients
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