Reduced blood loss after intra-articular tranexamic acid injection during total knee arthroplasty: a meta-analysis of the literature
Tóm tắt
The purpose of the study is to conduct a meta-analysis of randomized, controlled trials evaluating the efficacy and safety of intra-articular injection of tranexamic acid (TXA) for reducing blood loss and transfusion in patients undergoing total knee arthroplasty (TKA). A meta-analysis was conducted of RCTs published before March 2013, identified from the PubMed, EMBase, Cochrane library, ScienceDirect, and other databases. Two independent reviewers assessed the methodological quality of the studies and performed data extraction. Mean difference in blood loss and blood transfusions, risk ratios of transfusion rates, and deep vein thrombosis (DVT) incidence in the TXA-treated group versus placebo group were pooled from the included studies. Data were analysed using Stata 11.0 software. Six studies were included, with a total sample size of 647 patients. The use of TXA significantly reduced total blood loss (mean difference: −344.96; 95 % confidence interval (CI) −401.20 to −239.68; P < 0.01) and the proportion of patients requiring blood transfusions (risk ratios, 0.28; 95 % CI: 0.19–0.42; P < 0.01). There were no significant differences in the incidence of DVT, pulmonary embolism, or other complications between the study groups. The present meta-analysis indicated that intra-articular injection of TXA in patients undergoing TKA may reduce total blood loss and the need for blood transfusions, particularly when a high dosage of TXA is used (≥30 mg/ml), without any increase in the risk of post-operative DVT. II.
Tài liệu tham khảo
Baric D, Biocina B, Unic D, Sutlic Z, Rudez I, Vrca VB, Brkic K, Ivkovic M (2007) Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind prospective, randomized study. Eur J Cardiothorac Surg 31(3):366–371
Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 81(1):2–10
Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE (2004) Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 19:281–287
Cardone D, Klein AA (2009) Perioperative blood conservation. Eur J Anaesth 26(9):722–729
Cid J, Lozano M (2005) Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion 45(8):1302–1307
Dillon CF, Rasch EK, Gu Q, Hirsch R (2006) Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991–94. J Rheumatol 33:271–279
Ekback G, Axelsson K, Ryttberg L, Edlund B, Kjellberg J, Weckstrom J, Carlsson O, Schott U (2000) Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg 91(5):1124–1130
Endres S, Heinz M, Wilke A (2011) Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study. BMC Surg 11:29
Fawzy H, Elmistekawy E, Bonneau D, Latter D, Errett L (2009) Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial. J Cardiothorac Surg 18(4):25
Freedman J, Luke K, Monga N, Lincoln S, Koen R, Escobar M, Chiavetta J (2005) A provincial program of blood conservation: the Ontario Transfusion Coordinators (ONTraC). Transfus Apher Sci 33:343–349
Gibbons CE, Solan MC, Ricketts DM, Patterson M (2001) Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial. Int Orthop 25(4):250–252
Gillette BP, DeSimone LJ, Trousdale RT, Pagnano MW, Sierra RJ (2012) Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty. Clin Orthop Relat Res 471(1):150–154
Good L, Peterson E, Lisander B (2003) Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 90(5):596–599
Goodnough LT, Verbrugge D, Marcus RE (1995) The relationship between hematocrit, blood lost, and blood transfused in total knee replacement. Implications for postoperative blood salvage and reinfusion. Am J Knee Surg 8:83–87
Hardy JF, Bélisle S (1997) Natural and synthetic antifibrinolytics: inert, poisonous or therapeutic agents? Can J Anaesth 44(9):913–917
Higgins J, Green S (2008) Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions version 5.0.0. The Cochrane collaboration: http://hiv.cochrane.org/sites/hivcochrane.org/files/uploads/Ch08_Bias.pdf
Ishida K, Tsumura N, Kitagawa A, Hamamura S (2011) Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 35(11):1639–1645
Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W (2009) Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res 123(5):687–696
Lanes SF, Lanza LL, Radensky PW, Yood RA, Meenan RF, Walker AM, Dreyer NA (1997) Resource utilization and cost of care for rheumatoid arthritis and osteoarthritis in a managed care setting: the importance of drug and surgery costs. Arthritis Rheum 40(8):475–481
Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR (2012) Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 490(12):2605–2612
Mannucci PM (1998) Hemostatic drugs. N Engl J Med 339(4):245–253
Orpen NM, Little C, Walker G, Crawfurd EJ (2006) Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee 13(2):106–110
Philips B, Ball C, Sackett (2009). http://www.cebm.net
Rajesparan K, Biant LC, Ahmad M, Field RE (2009) The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Am 6(91):776–783
Ross J, Al-Shahi Salman R (2012) The frequency of thrombotic events among adults given antifibrinolytic drugs for spontaneous bleeding: systematic review and meta-analysis of observational studies and randomized trials. Curr Drug Safety 7(1):44–54
Roy SP, Tanki UF, Dutta A, Jain SK, Nagi ON (2012) Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(12):2499–2501
Sa-Ngasoongsong P, Channoom T, Kawinwonggowit V, Woratanarat P, Chanplakorn P, Wibulpolprasert B, Wongsak S, Udomsubpayakul U, Wechmongkolgorn S, Lekpittaya N (2011) Postoperative blood loss reduction in computer-assisted surgery total knee replacement by low dose intra-articular tranexamic acid injection together with 2-hour clamp drain: a prospective triple-blinded randomized controlled trial. Orthop Rev 3(2):e12
Seo JG, Moon YW, Park SH, Kim SM, Ko KR (2011) The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total. knee arthroplasty. J Knee Sury Sports Traumatol Arthrosc 21(8):1869–1874
Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, Syed KA, Muhammad Ovais Hasan S, De Silva Y, Chung F (2010) Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 92(15):2503–2513
Zanasi S (2011) Innovations in total knee replacement: new trends in operative treatment and changes in peri-operative management. Eur Orthop Traumatol 2(1–2):21–31
Zhang H, Chen J, Chen F, Que W (2012) The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Sury Sports Traumtol Arthrosc 20(9):1742–1752
Zhang Y, Qin Q, HaiShan W (2009) A meta-analysis of tranexamic acid to reduce blood loss in total knee arthroplasty. Chin J Orthop 29:524–529
Li Z-J, Xin F, Xing D, Zhang H-F, Zang J-C, Ma X-L (2013) Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur Spine J 22(9):1950–1957
Zufferey P, Merquiol F, Laporte S, Decousus H (2006) Do antifibrinolytics reduce allogeneic blood transfusion in orthopaedic surgery? Anesthesiology 105(5):1034–1046