Abstract
Introduction
Total knee replacements (TKR) are among the commonest operations performed in orthopaedic practice. Literature review showed that 10-30% of patients who underwent TKR needed 1-3 units of blood.
Tranexamic acid (TXA) has been popularised as an effective way to reduce blood loss and subsequent blood transfusion.
Our aim was to investigate the value of TXA in reducing blood loss and blood transfusion after TKR and other clinical outcomes such as deep venous thrombosis (DVT), pulmonary embolism (PE), ischaemic heart diseases and mortality.
Patients and Methods
A systematic review and meta-analysis of published randomised and quasi-randomised trials which used TXA to reduce blood loss in knee arthroplasty were conducted.
Results
18 clinical trials were considered suitable for detailed data extraction. There were no trials which utilised TXA in revision TKR.
Blood loss
Fourteen studies (885 patients) were eligible for this outcome. Using TXA significantly reduced postoperative blood loss by an average of 203.64.65 ml (P-value <0.00001, 95% CI -177.44-229.84, I2 =89 %) and total blood loss by an average of 591.44 ml (P-value <0.00001, 95% CI -646.82-536.06, I2 =78 %).
Blood transfusion
Sixteen studies (1085 patients) were eligible to measure the effect of TXA on blood transfusion after TKR. TXA led to a reduction in the proportion of patients who required blood transfusion (RD -0.34, P-value <0.00001, 95% CI -0.38-0.29, I2 =65).
Other outcomes
There were no significant differences in the length of hospital stay, DVT, PE, mortality, wound haematoma or infections between the study groups.
Conclusion
TXA appears effective and safe in reducing blood loss and allogeneic blood transfusion in primary TKR.
