title: The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis.
abstract: OBJECTIVE
  Total knee arthroplasty (TKA) is a popular procedure in severe osteoarthritis. But perioperative bleeding remains a problem. Floseal® is a mixture of thrombin and bovine gelatin which can benefit a lot on reducing intraoperative and postoperative bleeding. However, there is no enough evidence judging its safety and efficiency. So a meta-analysis is conducted by us to evaluate the efficacy and safety of a thrombin-based hemostatic agent compared with conventional methods in TKA.
  
  
  METHODS
  Two independent reviewers selected literatures published before August 2014 from MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials. Other internet databases were also performed to identify trials according to the Cochrane Collaboration guidelines. High-quality randomized controlled trials (RCTs), prospective control trials (PCTs), and case controlled trials (CCTs) were selected. The meta-analysis was undertaken using RevMan 5.1 for Windows.
  
  
  RESULTS
  Three RCTs, one PCT, and one CCT met the inclusion criteria. There were significant differences in hemoglobin decline and calculated total blood loss between the Floseal® group and control group. There were no significant differences in postoperative drainage volume, rate of transfusion requirement, incidence of wound infection, deep vein thrombosis (DVT), and pulmonary embolism (PE) between treatment and control groups.
  
  
  CONCLUSIONS
  The present meta-analysis indicates that a thrombin-based hemostatic agent can reduce hemoglobin decline and calculated total blood loss after TKA and is not related to adverse reactions or complications such as wound infection, DVT, and PE.
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. 850283129@qq.com.|Tianjin Medical University, Tianjin, 300070, People's Republic of China. 850283129@qq.com.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, People's Republic of China. 2008021116@tijmu.edu.cn.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Han
authors.affiliation: General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China. 2008021102@tijmu.edu.cn.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. 2008021103@tijmu.edu.cn.
authors.forename: Jian-xiong
authors.initials: JX
authors.lastname: Ma
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. 2008021203@tijmu.edu.cn.
authors.forename: Xuan
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. 2008021130@tijmu.edu.cn.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. 2008021123@tijmu.edu.cn.
authors.forename: Xin-long
authors.initials: XL
authors.lastname: Ma
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects / Q000627:therapeutic use*; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics