title: A systematic review and meta-analysis of the use of antifibrinolytic agents in total hip arthroplasty.
abstract: BACKGROUND
  Antifibrinolytic agents such as tranexamic acid (TXA), epsilon aminocaproic acid (EACA), and aprotinin are widely used to reduce bleeding and the need for transfusion in cardiac, orthopaedic, and hepatic surgery. We aimed to assess the efficacy and safety of antifibrinolytic agents in total hip arthroplasty (THA).
  
  
  METHODS
  A systematic literature search was performed using MEDLINE, PubMed, EMBASE, and Cochrane databases, as well as the reference lists of relevant articles. Only randomised 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 requirements and deep-vein thrombosis (DVT) were calculated in the antifibrinolytic agents-treated and control groups.
  
  
  RESULTS
  A total of 28 randomised controlled trials involving 2,131 patients were included. Patients receiving antifibrinolytic agents had a reduced total blood loss by a mean of 389.14 ml (95% CI, -483.05 to -295.23), and the number of blood transfusions per patient by 0.65 units (95% CI, -1.19 to -0.12). Antifibrinolytic agents led to a significant reduction in transfusion requirements (RR 0.55; 95% CI, 0.43 to 0.70) and no increase in the risk of DVT (RR 0.85; 95% CI, 0.51 to 1.42).
  
  
  CONCLUSIONS
  Our meta-analysis demonstrated that antifibrinolytic agents significantly reduce blood loss and blood transfusion requirements while not increasing the risk of DVT in patients undergoing total hip arthroplasty.
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui - PR China.
authors.forename: Fei
authors.initials: F
authors.lastname: Huang
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui - PR China.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui - PR China.
authors.forename: Zongsheng
authors.initials: Z
authors.lastname: Yin
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui - PR China.
authors.forename: Guangwen
authors.initials: G
authors.lastname: Ma
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui - PR China.
authors.forename: Jun
authors.initials: J
authors.lastname: Chang
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D006801:Humans
chemical_list: D000933:Antifibrinolytic Agents