title: Efficacy and Safety of Tranexamic Acid in Bilateral Total Knee Replacement: A Meta-Analysis and Systematic Review.
abstract: BACKGROUND Tranexamic acid (TXA) has been well documented to reduce blood loss and transfusion requirements in patients undergoing unilateral total knee arthroplasty (TKA). However, the efficacy and safety of TXA in simultaneous bilateral TKA have not been clearly defined. The aim of our study was to systematically review the existing evidence regarding the role of TXA in patients undergoing simultaneous bilateral TKA. MATERIAL AND METHODS A systematic search of all studies published through June 2014 was performed using Medline, EMBASE, OVID, and other databases. All studies that compared the efficacy and safety of TXA administration in simultaneous bilateral TKA patients were identified. The data from the included trials were extracted and analyzed regarding blood loss and transfusion rates. The evidence quality levels of the selected articles were evaluated using a grading system. RESULTS Six studies were included, in which a total of 245 patients received TXA and 271 patients were controls. Overall, the results demonstrated that the use of TXA significantly reduced total blood loss by a mean of 371.1 ml (95% confidence interval (CI)=-412.12 to -330.09; p<0.001) and reduced the number of patients requiring blood transfusion (risk ratio (RR)=0.16; 95% CI=0.10 to 0.28; p<0.001). No significant differences in adverse effects such as deep vein thrombosis (DVT) or pulmonary embolism (PE) were noted in any group. CONCLUSIONS The intravenous use of TXA in patients undergoing simultaneous bilateral TKA is effective and safe and results in significantly reduced estimated blood loss and transfusion rates. No significant difference was observed in the incidence of side effects. Due to the limitations in the evidence quality of current meta-analyses, well-conducted, larger, high-quality randomized controlled trials (RCTs) are required.
authors.affiliation: Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Peiheng
authors.initials: P
authors.lastname: He
authors.affiliation: Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Ziji
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Nanning People's Hospital, Nanning, Guangxi, China (mainland).
authors.forename: Yumin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Dongliang
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D014148:Tranexamic Acid / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D014148:Tranexamic Acid