The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: a meta-analysis.
BACKGROUND
Conflicting reports have been published regarding the effect of tranexamic acid (TXA) on reducing blood loss and transfusion in patients undergoing orthopedic surgery. We performed a meta-analysis to evaluate the effectiveness and safety of TXA treatment in reducing blood loss and transfusion in major orthopedic surgery.


METHODS
MEDLINE, PubMed, EMBASE, and Cochrane databases were searched for relevant studies. Only randomized controlled trials were eligible for this study. The weighted mean difference in blood loss, number of transfusions per patient, and the summary risk ratio of transfusion and deep vein thrombosis (DVT) were calculated in the TXA-treated group and the control group.


RESULTS
A total of 46 randomized controlled trials involving 2925 patients were included. The use of TXA reduced total blood loss by a mean of 408.33 mL (95% confidence interval [CI], -505.69 to -310.77), intraoperative blood loss by a mean of 125.65 mL (95% CI, -182.58 to -68.72), postoperative blood loss by a mean of 214.58 mL (95% CI, -274.63 to -154.52), the number of blood transfusions per patient by 0.78 U (95% CI, -0.19 to -0.37), and the volumes of blood transfusions per patient by 205.33 mL (95% CI, -301.37 to -109.28). TXA led to a significant reduction in transfusion requirements (relative risk, 0.51; 95% CI, 0.46-0.56), and no increase in the risk of DVT (relative risk, 1.11; 95% CI, 0.69-1.79).


CONCLUSIONS
TXA significantly reduced blood loss and blood transfusion requirements in patients undergoing orthopedic surgery, and did not appear to increase the risk of DVT.
Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
Fei
F
Huang
Dan
D
Wu
Guangwen
G
Ma
Zongsheng
Z
Yin
Qing
Q
Wang
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001810:Blood Volume; D006801:Humans; D019637:Orthopedic Procedures; D014148:Tranexamic Acid / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000139:chemically induced
D000889:Anti-Arrhythmia Agents; D014148:Tranexamic Acid
Blood loss; Meta-analysis; Tranexamic acid; Transfusion