TY - JOUR
T1 - The Efficacy of Tranexamic Acid in Total Knee 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 also 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 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.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/10
Y1 - 2018/10
N2 - Background: A growing body of published research on tranexamic acid (TXA) suggests that it is effective in reducing blood loss and the risk for transfusion in total knee arthroplasty (TKA). The purpose of this network meta-analysis was to evaluate TXA in primary TKA as the basis for the efficacy recommendations of 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: We searched Ovid MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases for publications before July 2017 on TXA in primary total joint arthroplasty. All included studies underwent qualitative and quantitative homogeneity testing. Direct and indirect comparisons were performed as a network meta-analysis, and results were tested for consistency. Results: After critical appraisal of the available 2113 publications, 67 articles were identified as representing the best available evidence. Topical, intravenous (IV), and oral TXA formulations were all superior to placebo in terms of decreasing blood loss and risk of transfusion, while no formulation was clearly superior. Use of repeat IV and oral TXA dosing and higher doses of IV and topical TXA did not significantly reduce blood loss or risk of transfusion. Preincision administration of IV TXA had inconsistent findings with a reduced risk of transfusion but no effect on volume of blood loss. Conclusions: Strong evidence supports the efficacy of TXA to decrease blood loss and the risk of transfusion after primary TKA. No TXA formulation, dosage, or number of doses provided clearly improved blood-sparing properties for TKA. Moderate evidence supports preincision administration of IV TXA to improve efficacy.
AB - Background: A growing body of published research on tranexamic acid (TXA) suggests that it is effective in reducing blood loss and the risk for transfusion in total knee arthroplasty (TKA). The purpose of this network meta-analysis was to evaluate TXA in primary TKA as the basis for the efficacy recommendations of 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: We searched Ovid MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases for publications before July 2017 on TXA in primary total joint arthroplasty. All included studies underwent qualitative and quantitative homogeneity testing. Direct and indirect comparisons were performed as a network meta-analysis, and results were tested for consistency. Results: After critical appraisal of the available 2113 publications, 67 articles were identified as representing the best available evidence. Topical, intravenous (IV), and oral TXA formulations were all superior to placebo in terms of decreasing blood loss and risk of transfusion, while no formulation was clearly superior. Use of repeat IV and oral TXA dosing and higher doses of IV and topical TXA did not significantly reduce blood loss or risk of transfusion. Preincision administration of IV TXA had inconsistent findings with a reduced risk of transfusion but no effect on volume of blood loss. Conclusions: Strong evidence supports the efficacy of TXA to decrease blood loss and the risk of transfusion after primary TKA. No TXA formulation, dosage, or number of doses provided clearly improved blood-sparing properties for TKA. Moderate evidence supports preincision administration of IV TXA to improve efficacy.
KW - antifibrinolytic
KW - blood loss
KW - total knee arthroplasty
KW - tranexamic acid
KW - transfusion
UR - http://www.scopus.com/inward/record.url?scp=85047299421&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047299421&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2018.04.043
DO - 10.1016/j.arth.2018.04.043
M3 - Article
AN - SCOPUS:85047299421
SN - 0883-5403
VL - 33
SP - 3090-3098.e1
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 10
ER -