Effectiveness and safety of tranexamic acid in total knee arthroplasty: a systematic review and meta-analysis

Abstract

INTRODUCTION: Major elective orthopedic surgery is often associated with blood loss, requiring the need for blood transfusion. A possible pharmacological option to reduce surgical blood loss in total arthroplasty is the use of tranexamic acid. The objective of the study was to undertake a meta-analysis investigating the effects of tranexamic acid on knee arthroplasty. MATERIAL AND METHODS: The study was designed as a systematic review and meta-analysis. The PubMed, Central, Web of Science, and Scopus databases were searched up to March 23, 2022, to identify randomized controlled trials concerning tranexamic acid (TXA) administration during knee arthroplasty. Overall and stratified pooled odds ratios (ORs) or mean differences (MDs) with their 95% confidence intervals (Cis) were obtained. RESULTS: Fifty-two articles were included. Pooled analysis showed that hemoglobin changes in TXA group was 3.4 ± 3.1, compared to 4.03 ± 2.62 for non-TXA group (MD = −1.30; 95% CI: –1.57 to –1.03; I2 = 99%; p<0.001). Total blood loss was reported in 31 trials and was statistically significantly lower in the TXA group compared to non-TXA (MD = –391.51; 95% CI: −454.29 to −328.73; p < 0.001). Intraoperative blood loss was lower when using TXA rather than non-TXA (MD = −32.10; 95% CI: −50.63 to −13.58; p < 0.001). 24-hours blood loss from the drain was also lower with TXA than with placebo (MD = −228.68; 95% CI: −293.31 to −164.05; p < 0.001). The above dependencies also applied to the intravenous as well as topical application of TXA. Blood transfusion was performed in 11.2% of patients from TXA group, compared to 34.3% of patients treated with placebo (OR = 0.16; 95% CI: 0.11 to 0.22; p < 0.001). Deep vein thrombosis (DVT) was observed in 4.6% of patients treated with TXA, compared to 5.8% of patients treated with placebo (OR = 0.81; 95% CI: 0.49 to 1.35; p = 0.42) and pulmonary embolism was 0.5% in TXA group and 1.4% in placebo group (OR = 0.44; 95% CI: 0.15 to 1.36; p = 0.15). CONCLUSIONS: Tranexamic acid is effective and safe in reducing blood loss, the requirement for blood transfusion, and drain output in patients undergoing knee arthroplasty.