A meta-analysis of topical use of tranexamic acid in total knee arthroplasty revealed it significantly reduces postoperative blood loss and transfusion requirements.
“This meta-analysis showed a statistically significant reduction of postoperative blood loss and transfusion requirements with topical use of [tranexamic acid] in total knee arthroplasties, without any additional thromboembolic risk,” Peter V. Giannoudis, MD, FRCS, EEC, and colleagues wrote in their study. “However, the clinical importance of the respective estimates of effect size is equivocal.”
Peter V. Giannoudis
Giannoudis and colleagues examined seven studies from the PubMed, Medline, Ovid Medline, Embase and Cochrane Library databases conducted between 1966 and 2013 that met their inclusion criteria of total knee arthroplasty performed in adults where the surgeon topically applied tranexamic acid (TXA).
Compared to controls, TXA significantly reduced mean total blood loss by 220.08 mL, mean hemoglobin (Hb) drop by 0.94 g/dL, and mean postoperative drain output by 268.36 mL.
TXA also reduced the risk of transfusion requirements without raising the risk for thromboembolic events. This association was confirmed through a subgroup analysis in which a higher dose of topical TXA significantly reduced transfusion requirements without increasing the thromboembolic event risk, according to the results.
“The summarized estimate of effect size for maximum Hb drop ... in essence was derived from studies belonging to the “low dose topical [TXA] subgroup,” Giannoudis and colleagues wrote. “It indicates that even lower doses of topically applied [TXA] resulted in a significantly reduced drop of postoperative Hb levels compared with the [control group].”
Disclosure: The authors have no relevant financial disclosures.