title: Effect of fibrin sealant on blood loss following total knee arthroplasty: a systematic review and meta-analysis.
abstract: OBJECTIVE
  A systematic review of randomized controlled trials was conducted to examine the efficacy of fibrin sealants for the reduction of postoperative blood loss and allogeneic red blood cell transfusion in total knee arthroplasty (TKA).
  
  
  METHODS
  Studies published through May 2013 were identified from PubMed, Embase, the Cochrane library, ScienceDirect, and other databases. Two independent reviewers assessed the quality of methodology using the Grade of Recommendations Assessment, Development and Evaluation approach and extracted data from literature. The mean difference (MD) of blood loss, hemoglobin loss, and risk ratios (RR) of transfusion rate and adverse events in the fibrin-treated and placebo groups were pooled throughout the study. The relevant data were analyzed using Stata 11.0 software.
  
  
  RESULTS
  Eight studies were included in the review, with a total sample size of 558 patients. The drainage blood loss [MD = -354.02 mL, 95% confidence interval (CI) (-500.87 to -207.18); P < 0.05], reduction in calculated total blood loss [MD = -402.12, 95% CI (-599.16 to -205.08); P < 0.05], hemoglobin loss [MD = -0.86 g/dL, 95% CI (-1.10 g/dL to -0.61 g/dL); P < 0.05], and transfusion rate [RR = 0.62, 95% CI (0.45-0.86); P < 0.05] were all significantly reduced following treatment with fibrin sealants. There were no significant differences in the incidence of adverse events [RR = 0.69, 95% CI (0.32-1.59); P > 0.05] among the study groups.
  
  
  CONCLUSIONS
  The results of the present meta-analysis suggest that fibrin sealants for patients undergoing TKA may reduce blood loss and maintain higher hemoglobin levels, particularly when fibrin sealants are used at higher dosage. Furthermore, fibrin sealants do not increase the risk of postoperative deep vein thrombosis, superficial infection, pulmonary embolism, and hematoma. Further evaluation is required to confirm our findings before fibrin sealants can be used in patients undergoing TKA.
  
  
  METHODS
  II.
authors: Tianjin Union Hospital, Department of Orthopedics, Tianjin 300121, PR China; Tianjin Medical University, Tianjin 30070, PR China.
authors: Jun
authors: J
authors: Liu
authors: Tianjin Medical University, Tianjin 30070, PR China.
authors: Jian-gang
authors: JG
authors: Cao
authors: Tianjin Medical University, Tianjin 30070, PR China.
authors: Lei
authors: L
authors: Wang
authors: Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin 300052, PR China; Department of Orthopedics, Tianjin Hospital, Tianjin 300211, PR China. Electronic address: orthodoc969@gmail.com.
authors: Xin-long
authors: XL
authors: Ma
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives
keywords: Blood loss; Fibrin sealant; Meta-analysis; Surgical; Total knee arthroplasty