1.
Tranexamic acid versus aminocaproic acid for blood management after total knee and total hip arthroplasty: a systematic review and meta-analysis
Liu Q, Geng P, Shi, Wang Q, Wang P
International Journal of Surgery (London, England). 2018;54((Pt A):):105-112
Abstract
OBJECTIVE To compare the efficacy and safety of tranexamic acid and aminocaproic acid for reducing blood loss and transfusion requirements after total knee and total hip arthroplasty. METHODS We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11) and the Cochrane Library (1900-2017.11). The primary outcomes, including total blood loss, hemoglobin decline and transfusion requirements. Secondary outcomes include length of hospital stay and postoperative complications such as the incidence of deep vein thrombosis and pulmonary embolism. Each outcome is combined and calculated using the statistical software STATA 12.0. Fixed/random effect model is adopted based on the heterogeneity tested by I(2) statistic. RESULTS A total of 1,714 patients are analyzed across three randomized controlled trials (RCTs) and one non-RCT. The present meta-analysis reveals that TXA is associated with a significantly reduction of total blood loss and postoperative hemoglobin drop compared with EACA. No significant differences are identified in terms of transfusion rates, length of hospital stay, and the incidence of postoperative complications. CONCLUSION Although total blood loss and postoperative hemoglobin drop are significant greater in EACA groups, there is no significant difference between TXA and EACA groups in terms of transfusion rates. Based on the current evidence available, higher quality RCTs are still required for further research.
2.
A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty
Tan J, Chen H, Liu Q, Chen C, Huang W
Journal of Surgical Research. 2013;184((2):):880-7.
Abstract
BACKGROUND To evaluate the effectiveness and safety of tranexamic acid (TEA) treatment in reducing perioperative blood loss and transfusion for patients receiving primary unilateral total knee arthroplasty (TKA) and to explore the most effective and safe protocol. MATERIALS AND METHODS This study was based on Cochrane methodology for conducting meta-analyses. Only randomized controlled trials were eligible for this study. The participants were adults who had undergone primary unilateral TKA. The Review Manager Database (RevMan version 5.0, The Cochrane Collaboration, 2008) was used to analyze selected studies. RESULTS Nineteen randomized controlled trials involving 1114 patients were included. The use of TEA reduced postoperative drainage by a mean of 290 mL (95% confidence interval [CI] -385 to -196], total blood loss by a mean of 570 mL (95% CI -663 to -478), the number of blood transfusions per patient by 0.96 units (95% CI -1.32 to -0.59), and the volumes of blood transfusions per patient -440 mL (95% CI -518 to -362). TEA led to a significant reduction in the proportion of patients requiring blood transfusion (relative risk 0.39). There were no significant differences in venous thromboembolism or other adverse events among the study groups. CONCLUSIONS Intravenous TEA could significantly reduce perioperative blood loss and blood transfusion requirements following primary unilateral TKA. Its application is not associated with increased risk of venous thromboembolisms or other adverse events. Copyright 2013 Elsevier Inc. All rights reserved.