title: Tranexamic acid in total knee replacement: a systematic review and meta-analysis.
abstract: We conducted a systematic review and meta-analysis of randomised controlled trials evaluating the effect of tranexamic acid (TXA) upon blood loss and transfusion in primary total knee replacement. The review used the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. A total of 19 trials were eligible: 18 used intravenous administration, one also evaluated oral dosing and one trial evaluated topical use. TXA led to a significant reduction in the proportion of patients requiring blood transfusion (risk ratio (RR) 2.56, 95% confidence interval (CI) 2.1 to 3.1, p < 0.001; heterogeneity I(2) = 75%; 14 trials, 824 patients). Using TXA also reduced total blood loss by a mean of 591 ml (95% CI 536 to 647, p < 0.001; I(2) = 78%; nine trials, 763 patients). The clinical interpretation of these findings is limited by substantial heterogeneity. However, subgroup analysis of high-dose (> 4 g) TXA showed a plausible consistent reduction in blood transfusion requirements (RR 5.33; 95% CI 2.44 to 11.65, p < 0.001; I(2) = 0%), a finding that should be confirmed by a further well-designed trial. The current evidence from trials does not support an increased risk of deep-vein thrombosis (13 trials, 801 patients) or pulmonary embolism (18 trials, 971 patients) due to TXA administration.
authors.affiliation: The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK. sattar26@doctors.org.uk
authors.forename: S
authors.initials: S
authors.lastname: Alshryda
authors.forename: P
authors.initials: P
authors.lastname: Sarda
authors.forename: M
authors.initials: M
authors.lastname: Sukeik
authors.forename: A
authors.initials: A
authors.lastname: Nargol
authors.forename: J
authors.initials: J
authors.lastname: Blenkinsopp
authors.forename: J M
authors.initials: JM
authors.lastname: Mason
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011655:Pulmonary Embolism / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000139:chemically induced
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid