A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement

Bone and Joint Journal - Tập 96-B Số 8 - Trang 1005-1015 - 2014
Sattar Alshryda1, Mohamed Sukeik2, Praveen Sarda3, John Blenkinsopp4, Fares S. Haddad5, James Mason6
1Central Manchester Hospitals, Oxford#N#Road, Manchester, M13#N#9WL, UK.
2University College London Hospital, 235#N#Euston Road, London NW1 2BU, UK.
3Medway Maritime Hospital, Windmill#N#Road, Gillingham, Kent, ME7#N#5NY, UK.
4University Hospital of North Tees and#N#Hartlepool, Hardwick Road, Stockton-On-Tees#N#TS19 8PE, UK.
5University College London Hospitals, 235#R#Euston Road, London, NW1#R#2BU, UK.
6Durham University, Durham#R#Clinical Trials Unit, University Boulevard, Stockton-On-Tees, TS17#R#6BH, UK.

Tóm tắt

Intravenous tranexamic acid (TXA) has been shown to be effective in reducing blood loss and the need for transfusion after joint replacement. Recently, there has been interest in applying it topically before the closure of surgical wounds. This has the advantages of ease of application, maximum concentration at the site of bleeding, minimising its systemic absorption and, consequently, concerns about possible side-effects. We conducted a systematic review and meta-analysis which included 14 randomised controlled trials (11 in knee replacement, two in hip replacement and one in both) which investigated the effect of topical TXA on blood loss and rates of transfusion. Topical TXA significantly reduced the rate of blood transfusion (total knee replacement: risk ratio (RR) 4.51; 95% confidence interval (CI): 3.02 to 6.72; p < 0.001 (nine trials, I2 = 0%); total hip replacement: RR 2.56; 95% CI: 1.32 to 4.97, p = 0.004 (one trial)). The rate of thromboembolic events with topical TXA were similar to those found with a placebo. Indirect comparison of placebo-controlled trials of topical and intravenous TXA indicates that topical administration is superior to the intravenous route. In conclusion, topical TXA is an effective and safe method of reducing the need for blood transfusion after total knee and hip replacement. Further research is required to find its optimum dose for topical use. Cite this article: Bone Joint J 2014;96-B:1005–15.

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Thông tin xuất bản

Bone and Joint Journal

Tập 96-B Số 8

1005-1015

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