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The Safety Profile and Outcomes of Tranexamic Acid for Total Ankle Arthroplasty: A Systematic Review
Rodrigo Encinas1, Sarah Hall Kiriluk, Jack Hardman
1From Orlando Health Orthopaedic Surgery, Orlando, FL (Encinas and Hardman), University of South Carolina, School of Medicine, Columbia, SC (Kiriluk), and Prisma Health Orthopaedic Surgery, Lexington, SC (Jackson and Gonzalez).
Background:
Tranexamic acid (TXA) is frequently used in knee and hip arthroplasty because of its benefits. The literature is scarce on TXA and total ankle arthroplasty (TAA). The current systematic review aims to present the available literature on the subject.
Methods:
Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. The search criteria were based on TAA and TXA. The MINORS score criteria were used to evaluate the strength and quality of the selected studies.
Results:
A total of eight studies including 263 TAA were completed with the usage of TXA and 228 TAA were without TXA. The average blood loss and change in hemoglobin in the TXA group was 335.4 mL and 1.45 g/dL, respectively. In the non-TXA group, average blood loss and change in hemoglobin was 441.8 mL and 1.78 g/dL, respectively. The total number of complications and wound complications reported in all studies for the TXA group were 19% and 6.8%; in the non-TXA group, 33.3% and 16.7% were observed, respectively. The difference in wound complication rate was statistically significant ( P = 0.014). Trends favoring the TXA group were found for lower transfusion, pulmonary embolism, deep vein thrombosis, and cerebrovascular accident.
Conclusion:
The utilization of TXA in TAA appears to be safe and effective. Wound complication rate was the only finding with a notable difference favoring the TXA group. The rest of the data from this systematic review demonstrate a trend toward lower in blood loss, hemoglobin decrease, and total complications when using TXA in TAA. Larger prospective studies and randomized controlled trials are needed to further guide evidence-based guidelines.
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