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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

Forest plot and tabulated data illustrating the mean difference (MD) in the blood loss between TXA and placebo group, showing that TXA administration significantly reduce the total blood loss.
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f4-medscimonit-21-3634: Forest plot and tabulated data illustrating the mean difference (MD) in the blood loss between TXA and placebo group, showing that TXA administration significantly reduce the total blood loss.

Mentions: Total blood loss was evaluated in 4 trials, in which a total of 178 patients received TXA and 162 patients served as controls. The pooled WMD for all patients was calculated, and the data demonstrated that TXA administration significantly reduced total blood loss by a mean of 371.1 ml (95% CI=−412.12 to −330.09; p<0.001). However, significant heterogeneity was observed (p<0.001; I2=92%) among the included studies (Figure 4).


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)

Forest plot and tabulated data illustrating the mean difference (MD) in the blood loss between TXA and placebo group, showing that TXA administration significantly reduce the total blood loss.
© Copyright Policy
Related In: Results  -  Collection

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

f4-medscimonit-21-3634: Forest plot and tabulated data illustrating the mean difference (MD) in the blood loss between TXA and placebo group, showing that TXA administration significantly reduce the total blood loss.
Mentions: Total blood loss was evaluated in 4 trials, in which a total of 178 patients received TXA and 162 patients served as controls. The pooled WMD for all patients was calculated, and the data demonstrated that TXA administration significantly reduced total blood loss by a mean of 371.1 ml (95% CI=−412.12 to −330.09; p<0.001). However, significant heterogeneity was observed (p<0.001; I2=92%) among the included studies (Figure 4).

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