Abstract
Introduction
Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI).
Materials and methods
Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case–control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I).
Results
Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49–0.62) (P < 0.00001), and that of PJI alone (OR 0.53; 95% CI 0.47–0.59) (P < 0.00001). TXA reduced the incidence of overall infection in patients who underwent total hip arthroplasty (THA; OR 0.51; 95% CI: 0.35–0.75) (P = 0.0005) and total knee arthroplasty (TKA; OR 0.55; 95% CI: 0.43–0.71) (P < 0.00001). Intravenous administration of TXA reduced the incidence of overall infection (OR 0.59; 95% CI 0.47–0.75) (P < 0.0001), whereas topical administration did not.
Conclusions
Intravenous administration of TXA reduces the incidence of overall infection in patients undergoing both THA and TKA.
Level of evidence
Level III.
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Data availability
The data that support the findings of this study are available from the corresponding author, [N.K.], upon reasonable request.
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Imanishi, K., Kobayashi, N., Kamono, E. et al. Tranexamic acid administration for the prevention of periprosthetic joint infection and surgical site infection: a systematic review and meta-analysis. Arch Orthop Trauma Surg 143, 6883–6899 (2023). https://doi.org/10.1007/s00402-023-04914-x
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DOI: https://doi.org/10.1007/s00402-023-04914-x