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Archives of Orthopaedic and Trauma Surgery

, Volume 135, Issue 4, pp 573–588 | Cite as

One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration

  • Hamidreza ShemshakiEmail author
  • Sayed Mohammad Amin Nourian
  • Niloofaralsadat Nourian
  • Masoudhatef Dehghani
  • Masoud Mokhtari
  • Farhad Mazoochian
Knee Arthroplasty

Abstract

Background

Tranexamic acid (TXA) in orthopedics has recently been gaining favor due to its efficacy and ease of use, both in intravenous (IV) and intraarticular (IA) usage. However, because of safety concerns with IV administration, there has been a growing interest in the IA use of TXA to prevent bleeding.

Materials and methods

This study conducted a systematic review and meta-analysis that included 31 randomized, controlled trials in which the effect of systemic and topical TXA on total blood loss (TBL), rates of transfusion, and thromboembolic events was investigated.

Results

Compared to the control, the IA administration of TXA led to the significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and reduction of rate of thromboembolic events (p = 0.29). Compared to the control group, the IV administration of TXA resulted in significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and rate of thromboembolic events (p = 0.66). Although no significant differences in efficacy and safety between the IA and IV administration of TXA were found, the IA method was safer than the IV method in that it reduced rate of transfusion and thromboembolic events.

Conclusion

This study showed that TXA leads to significant reductions in TBL and the rate of allogeneic transfusions. Generally, no significant difference was detected between IA and IV administration of TXA; however, more studies with focus on safety and efficacy are warranted.

Keywords

Tranexamic acid Meta-analysis Intraarticular Intravenous Total knee arthroplasty 

Notes

Acknowledgments

We are all thankful for the editing assistance that Mahboobeh Fereidan-Esfahani (Isfahan University of Medical Sciences, Iran) provided.

Conflict of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Hamidreza Shemshaki
    • 1
    Email author
  • Sayed Mohammad Amin Nourian
    • 2
  • Niloofaralsadat Nourian
    • 3
  • Masoudhatef Dehghani
    • 4
  • Masoud Mokhtari
    • 5
  • Farhad Mazoochian
    • 6
  1. 1.Orthopaedic Surgery DepartmentCrona Clinik, Eberhard Karls UniversityTuebingenGermany
  2. 2.Department of Biological SciencesCalifornia State UniversityTurlockUSA
  3. 3.Najafabad Azad University of Medical SciencesNajafabadIran
  4. 4.Department of Orthopedic SurgerySaadi HospitalIsfahanIran
  5. 5.Isfahan University of Medical SciencesIsfahanIran
  6. 6.Department of Orthopedic SurgeryUniversity of Munich (LMU)MunichGermany

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