TY - JOUR
T1 - The Efficacy of Tranexamic Acid in Total Hip Arthroplasty
T2 - A Network Meta-analysis
AU - Fillingham, Yale A.
AU - Ramkumar, Dipak B.
AU - Jevsevar, David S.
AU - Yates, Adolph J.
AU - Shores, Peter
AU - Mullen, Kyle
AU - Bini, Stefano A.
AU - Clarke, Henry D.
AU - Schemitsch, Emil
AU - Johnson, Rebecca L.
AU - Memtsoudis, Stavros G.
AU - Sayeed, Siraj A.
AU - Sah, Alexander P.
AU - Della Valle, Craig J.
N1 - Funding Information:
The authors would like to thank the American Association of Hip and Knee Surgeons for providing funding for this study. They would like to thank Jayson Murray from the American Academy of Orthopaedic Surgeons Department of Research, Quality, and Scientific Affairs for his assistance with oversight of the quality assessment, data extraction, and statistical analysis. They would like to thank Thomas Mead for his expertise as a research librarian to assist with development of the database searches. Finally, they thank the leadership of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, American Society of Regional Anesthesia and Pain Medicine, and the Hip and Knee Societies for help with organizational support.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/10
Y1 - 2018/10
N2 - Background: Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to reduce blood loss in total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy of TXA in primary THA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine on the use of TXA in primary total joint arthroplasty. Methods: A search was performed using Ovid-MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases to identify all publications before July 2017 on TXA in primary THA. We completed qualitative and quantitative homogeneity testing of all included studies. Direct and indirect comparisons were analyzed using a network meta-analysis followed by consistency testing of the results. Results: Two thousand one hundred thirteen publications underwent critical appraisal with 34 publications identified as representing the best available evidence for inclusion in the analysis. Topical, intravenous, and oral TXA formulations provided reduced blood loss and risk of transfusion compared to placebo, but no formulation was clearly superior. Use of repeat doses, higher doses, or variation in timing of administration did not significantly reduce blood loss or risk of transfusion. Conclusions: Strong evidence supports the use of TXA to reduce blood loss and risk of transfusion after primary THA. No specific routes of administration, dosage, dosing regimen, or time of administration provides clearly superior blood-sparing properties.
AB - Background: Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to reduce blood loss in total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy of TXA in primary THA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine on the use of TXA in primary total joint arthroplasty. Methods: A search was performed using Ovid-MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases to identify all publications before July 2017 on TXA in primary THA. We completed qualitative and quantitative homogeneity testing of all included studies. Direct and indirect comparisons were analyzed using a network meta-analysis followed by consistency testing of the results. Results: Two thousand one hundred thirteen publications underwent critical appraisal with 34 publications identified as representing the best available evidence for inclusion in the analysis. Topical, intravenous, and oral TXA formulations provided reduced blood loss and risk of transfusion compared to placebo, but no formulation was clearly superior. Use of repeat doses, higher doses, or variation in timing of administration did not significantly reduce blood loss or risk of transfusion. Conclusions: Strong evidence supports the use of TXA to reduce blood loss and risk of transfusion after primary THA. No specific routes of administration, dosage, dosing regimen, or time of administration provides clearly superior blood-sparing properties.
KW - antifibrinolytic
KW - blood loss
KW - total hip arthroplasty
KW - tranexamic acid
KW - transfusion
UR - http://www.scopus.com/inward/record.url?scp=85049727087&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85049727087&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2018.06.023
DO - 10.1016/j.arth.2018.06.023
M3 - Article
AN - SCOPUS:85049727087
VL - 33
SP - 3083-3089.e4
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
SN - 0883-5403
IS - 10
ER -