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Efficacy and Safety of Tranexamic Acid in Bilateral Total Knee Replacement: A Meta-Analysis and Systematic Review.

He P, Zhang Z, Li Y, Xu D, Wang H - Med. Sci. Monit. (2015)

Bottom Line: Overall, the results demonstrated that the use of TXA significantly reduced total blood loss by a mean of 371.1 ml (95% confidence interval (CI)=-412.12 to -330.09; p<0.001) and reduced the number of patients requiring blood transfusion (risk ratio (RR)=0.16; 95% CI=0.10 to 0.28; p<0.001).No significant differences in adverse effects such as deep vein thrombosis (DVT) or pulmonary embolism (PE) were noted in any group.No significant difference was observed in the incidence of side effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).

ABSTRACT
BACKGROUND Tranexamic acid (TXA) has been well documented to reduce blood loss and transfusion requirements in patients undergoing unilateral total knee arthroplasty (TKA). However, the efficacy and safety of TXA in simultaneous bilateral TKA have not been clearly defined. The aim of our study was to systematically review the existing evidence regarding the role of TXA in patients undergoing simultaneous bilateral TKA. MATERIAL AND METHODS A systematic search of all studies published through June 2014 was performed using Medline, EMBASE, OVID, and other databases. All studies that compared the efficacy and safety of TXA administration in simultaneous bilateral TKA patients were identified. The data from the included trials were extracted and analyzed regarding blood loss and transfusion rates. The evidence quality levels of the selected articles were evaluated using a grading system. RESULTS Six studies were included, in which a total of 245 patients received TXA and 271 patients were controls. Overall, the results demonstrated that the use of TXA significantly reduced total blood loss by a mean of 371.1 ml (95% confidence interval (CI)=-412.12 to -330.09; p<0.001) and reduced the number of patients requiring blood transfusion (risk ratio (RR)=0.16; 95% CI=0.10 to 0.28; p<0.001). No significant differences in adverse effects such as deep vein thrombosis (DVT) or pulmonary embolism (PE) were noted in any group. CONCLUSIONS The intravenous use of TXA in patients undergoing simultaneous bilateral TKA is effective and safe and results in significantly reduced estimated blood loss and transfusion rates. No significant difference was observed in the incidence of side effects. Due to the limitations in the evidence quality of current meta-analyses, well-conducted, larger, high-quality randomized controlled trials (RCTs) are required.

No MeSH data available.


Related in: MedlinePlus

Summary of the article selection and exclusion process.
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f1-medscimonit-21-3634: Summary of the article selection and exclusion process.

Mentions: We conducted a computerized search of electronic databases, including the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, ISI Web of Knowledge, Science Direct and Google Scholar, for studies published through the end of June 2014. The following key terms were used to maximize search specificity and sensitivity: tranexamic acid, total knee arthroplasty and bilateral. The search strategy, encompassing studies conducted in humans and written in the English language, is presented in Figure 1. Secondary searches for additional relevant studies, such as those of the European Federation of National Associations of Orthopaedics and the British Orthopaedic Association Annual Congress, as well as conference proceedings until the end of June 2014, were also performed along with reference searches of the included articles to identify any additional studies that were not previously identified in the initial literature search.


Efficacy and Safety of Tranexamic Acid in Bilateral Total Knee Replacement: A Meta-Analysis and Systematic Review.

He P, Zhang Z, Li Y, Xu D, Wang H - Med. Sci. Monit. (2015)

Summary of the article selection and exclusion process.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4664225&req=5

f1-medscimonit-21-3634: Summary of the article selection and exclusion process.
Mentions: We conducted a computerized search of electronic databases, including the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, ISI Web of Knowledge, Science Direct and Google Scholar, for studies published through the end of June 2014. The following key terms were used to maximize search specificity and sensitivity: tranexamic acid, total knee arthroplasty and bilateral. The search strategy, encompassing studies conducted in humans and written in the English language, is presented in Figure 1. Secondary searches for additional relevant studies, such as those of the European Federation of National Associations of Orthopaedics and the British Orthopaedic Association Annual Congress, as well as conference proceedings until the end of June 2014, were also performed along with reference searches of the included articles to identify any additional studies that were not previously identified in the initial literature search.

Bottom Line: Overall, the results demonstrated that the use of TXA significantly reduced total blood loss by a mean of 371.1 ml (95% confidence interval (CI)=-412.12 to -330.09; p<0.001) and reduced the number of patients requiring blood transfusion (risk ratio (RR)=0.16; 95% CI=0.10 to 0.28; p<0.001).No significant differences in adverse effects such as deep vein thrombosis (DVT) or pulmonary embolism (PE) were noted in any group.No significant difference was observed in the incidence of side effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).

ABSTRACT
BACKGROUND Tranexamic acid (TXA) has been well documented to reduce blood loss and transfusion requirements in patients undergoing unilateral total knee arthroplasty (TKA). However, the efficacy and safety of TXA in simultaneous bilateral TKA have not been clearly defined. The aim of our study was to systematically review the existing evidence regarding the role of TXA in patients undergoing simultaneous bilateral TKA. MATERIAL AND METHODS A systematic search of all studies published through June 2014 was performed using Medline, EMBASE, OVID, and other databases. All studies that compared the efficacy and safety of TXA administration in simultaneous bilateral TKA patients were identified. The data from the included trials were extracted and analyzed regarding blood loss and transfusion rates. The evidence quality levels of the selected articles were evaluated using a grading system. RESULTS Six studies were included, in which a total of 245 patients received TXA and 271 patients were controls. Overall, the results demonstrated that the use of TXA significantly reduced total blood loss by a mean of 371.1 ml (95% confidence interval (CI)=-412.12 to -330.09; p<0.001) and reduced the number of patients requiring blood transfusion (risk ratio (RR)=0.16; 95% CI=0.10 to 0.28; p<0.001). No significant differences in adverse effects such as deep vein thrombosis (DVT) or pulmonary embolism (PE) were noted in any group. CONCLUSIONS The intravenous use of TXA in patients undergoing simultaneous bilateral TKA is effective and safe and results in significantly reduced estimated blood loss and transfusion rates. No significant difference was observed in the incidence of side effects. Due to the limitations in the evidence quality of current meta-analyses, well-conducted, larger, high-quality randomized controlled trials (RCTs) are required.

No MeSH data available.


Related in: MedlinePlus