Abstract
BackgroundTranexamic acid (TXA) has been demonstrated to minimize blood loss after total hip arthroplasty. There are three main routes: intravenous (IV), intra-articular (topical), and combined (IV and topical) but little consensus support which is most effective and safe. We performed network meta-analysis.to assess the comparative efficacy and safety of three different administration routes of TXA.MethodsTwenty-five randomized controlled trials (RCT) were evaluated. Interventions were classified as: combined, IV multiple, IV single, topical and placebo. The primary outcome was effectiveness (transfusion rate, total blood loss, and total drain out). The secondary outcome was safety, based on the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE).ResultsA total of 2227 patients were included in the 5 categories: 564 IV single, 319 IV multiple, 398 topical, 120 combined, and 826 placebo. A network meta-analysis identified the most effective interventions in terms of reducing the need for transfusion as follows: combined = 98.2%, IV single = 54.0%, IV multiple = 78.6%, topical = 66.1%, placebo = 0.0%. Compared with placebo, the IV single, IV multiple, topical, and combined interventions showed no difference in the rate of occurrence of DVT and PE.ConclusionsA network meta-analysis indicated that combined administration of TXA (IV and topical) was effective in reducing the transfusion rate after hip arthroplasty compared with IV or topical alone. As no high-risk patients were evaluated in the RCTs, it is not known whether the combined method is safer for patients susceptible to DVT or PE.
Highlights
Total hip arthroplasty (THA) provides excellent results in patients with end-stage hip disease. [1] blood loss during the procedure can be as much as 500 to 2000 ml, and the proportion of patients requiring transfusion range from 16% to 20%.[2, 3] To reduce blood loss and the need for transfusion, several prophylactic blood management protocols have been developed. [4]Tranexamic acid (TXA), a synthesized anti fibrinolytic agent, inhibits the conversion of plasminogen to plasmin by competitively binding to the lysine-binding sites of plasminogen. [5] it effectively reduces postoperative bleeding by inhibiting fibrinolysis and clot degradation
A network meta-analysis indicated that combined administration of TXA (IV and topical) was effective in reducing the transfusion rate after hip arthroplasty compared with IV or topical alone
As no high-risk patients were evaluated in the randomized controlled trials (RCT), it is not known whether the combined method is safer for patients susceptible to deep venous thrombosis (DVT) or pulmonary embolism (PE)
Summary
Total hip arthroplasty (THA) provides excellent results in patients with end-stage hip disease. [1] blood loss during the procedure can be as much as 500 to 2000 ml, and the proportion of patients requiring transfusion range from 16% to 20%.[2, 3] To reduce blood loss and the need for transfusion, several prophylactic blood management protocols have been developed. [4]Tranexamic acid (TXA), a synthesized anti fibrinolytic agent, inhibits the conversion of plasminogen to plasmin by competitively binding to the lysine-binding sites of plasminogen. [5] it effectively reduces postoperative bleeding by inhibiting fibrinolysis and clot degradation. Six pairwise meta-analyses of clinical trials using THA have shown that TXA applied topically or intravenously can decrease blood loss and transfusion rate without an increased risk of complications.[6,7,8,9,10,11] the optimal administration route for TXA to achieve efficacy and safety after THA is still controversial. Methods of application include topical, intravenous (IV), and combined IV and topical. It is unclear which of these methods is most effective to reduce total blood loss and to reduce total drain out. Tranexamic acid (TXA) has been demonstrated to minimize blood loss after total hip arthroplasty. There are three main routes: intravenous (IV), intra-articular (topical), and combined (IV and topical) but little consensus support which is most effective and safe. We performed network meta-analysis.to assess the comparative efficacy and safety of three different administration routes of TXA
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