Tranexamic acid in total knee replacement: a systematic review and meta-analysis

Area of Science:

• Orthopedic Surgery
• Pharmacology
• Evidence-Based Medicine

Background:

• Primary total knee replacement is associated with significant blood loss and transfusion requirements.
• Managing perioperative bleeding is crucial for patient outcomes and healthcare costs.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials on tranexamic acid's (TXA) efficacy in reducing blood loss and transfusion rates in primary total knee replacement.
• To assess the safety profile of TXA regarding deep-vein thrombosis and pulmonary embolism.

Main Methods:

• Systematic review and meta-analysis of 19 randomized controlled trials.
• Included trials evaluated intravenous, oral, or topical administration of TXA.
• Data synthesis using risk ratios and mean differences, assessing heterogeneity.

Main Results:

• TXA significantly reduced the proportion of patients requiring blood transfusion (RR 2.56, 95% CI 2.1 to 3.1).
• TXA reduced total blood loss by an average of 591 ml (95% CI 536 to 647).
• Subgroup analysis of high-dose TXA (> 4g) demonstrated a consistent reduction in transfusion needs (RR 5.33).

Conclusions:

• TXA is effective in reducing blood loss and transfusion requirements following primary total knee replacement.
• High-dose TXA appears particularly effective, warranting further investigation in well-designed trials.
• Current evidence does not indicate an increased risk of deep-vein thrombosis or pulmonary embolism with TXA use.