The Efficacy of Tranexamic Acid in Total Knee Arthroplasty

A Network Meta-Analysis

Yale A. Fillingham, Dipak B. Ramkumar, David S. Jevsevar, Adolph J. Yates, Peter Shores, Kyle Mullen, Stefano A. Bini, Henry D. Clarke, Emil Schemitsch, Rebecca L. Johnson, Stavros G. Memtsoudis, Siraj A. Sayeed, Alexander P. Sah, Craig J. Della Valle

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Tranexamic Acid
Knee Replacement Arthroplasties
Arthroplasty
Intravenous Administration
Publications
Network Meta-Analysis
Joints
Blood Volume
Practice Guidelines
MEDLINE
Hip

Keywords

  • antifibrinolytic
  • blood loss
  • total knee arthroplasty
  • tranexamic acid
  • transfusion

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Fillingham, Y. A., Ramkumar, D. B., Jevsevar, D. S., Yates, A. J., Shores, P., Mullen, K., ... Della Valle, C. J. (Accepted/In press). The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis. Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2018.04.043

The Efficacy of Tranexamic Acid in Total Knee Arthroplasty : A Network Meta-Analysis. / Fillingham, Yale A.; Ramkumar, Dipak B.; Jevsevar, David S.; Yates, Adolph J.; Shores, Peter; Mullen, Kyle; Bini, Stefano A.; Clarke, Henry D.; Schemitsch, Emil; Johnson, Rebecca L.; Memtsoudis, Stavros G.; Sayeed, Siraj A.; Sah, Alexander P.; Della Valle, Craig J.

In: Journal of Arthroplasty, 01.01.2018.

Research output: Contribution to journalArticle

Fillingham, YA, Ramkumar, DB, Jevsevar, DS, Yates, AJ, Shores, P, Mullen, K, Bini, SA, Clarke, HD, Schemitsch, E, Johnson, RL, Memtsoudis, SG, Sayeed, SA, Sah, AP & Della Valle, CJ 2018, 'The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis', Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2018.04.043
Fillingham, Yale A. ; Ramkumar, Dipak B. ; Jevsevar, David S. ; Yates, Adolph J. ; Shores, Peter ; Mullen, Kyle ; Bini, Stefano A. ; Clarke, Henry D. ; Schemitsch, Emil ; Johnson, Rebecca L. ; Memtsoudis, Stavros G. ; Sayeed, Siraj A. ; Sah, Alexander P. ; Della Valle, Craig J. / The Efficacy of Tranexamic Acid in Total Knee Arthroplasty : A Network Meta-Analysis. In: Journal of Arthroplasty. 2018.
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abstract = "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.",
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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.

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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.

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