Abstract
Background and aim
Total hip replacements (THRs) are associated with significant blood loss which often requires high transfusion rates of allogeneic blood. Although safer than ever, allogeneic blood transfusion is still associated with risks to the recipients. This meta-analysis aims to investigate the efficacy and safety of tranexamic acid (TXA) in reducing blood loss and allogeneic blood transfusion after THR.
Patients and Methods
A systematic review and meta-analysis of published randomised controlled trials which used TXA to reduce blood loss and transfusion in hip arthroplasty were conducted. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group.
Results
We identified 11 clinical trials which were suitable for detailed data extraction. There were no trials which utilised TXA in revision THR. Seven studies (350 patients) were eligible for the blood loss outcome. Using TXA reduced intraoperative blood loss by an average of 104 ml (95% Confidence Interval (CI) -164 to -44, P-value 0.0006, Heterogeneity I2 0%), post-operative blood loss by an average of 172 ml (95% CI -263 to -81, P-value 0.0002, Heterogeneity I2 63%) and total blood loss by an average of 289 ml (95% CI -440 to -138, P-value < 0.0002, Heterogeneity I2 54%). TXA led to a significant reduction in the proportion of patients requiring allogeneic blood transfusion (Risk Difference -0.20, 95% CI -0.29 to -0.11, P-value < 0.00001, I2 15%). There were no significant differences in deep venous thrombosis, pulmonary embolisms, infection rates or other complications between the study groups.
Conclusion
TXA appears effective and safe in reducing blood loss and allogeneic blood transfusion in primary THRs.
