1.
A systematic review and meta-analysis of the use of antifibrinolytic agents in total hip arthroplasty
Huang F, Wu Y, Yin Z, Ma G, Chang J
Hip International. 2015;25((6)):502-9.
Abstract
BACKGROUND Antifibrinolytic agents such as tranexamic acid (TXA), epsilon aminocaproic acid (EACA), and aprotinin are widely used to reduce bleeding and the need for transfusion in cardiac, orthopaedic, and hepatic surgery. We aimed to assess the efficacy and safety of antifibrinolytic agents in total hip arthroplasty (THA). METHODS A systematic literature search was performed using MEDLINE, PubMed, EMBASE, and Cochrane databases, as well as the reference lists of relevant articles. Only randomised controlled trials were eligible for this study. The weighted mean difference in blood loss, number of transfusions per patient, and the summary risk ratio of transfusion requirements and deep-vein thrombosis (DVT) were calculated in the antifibrinolytic agents-treated and control groups. RESULTS A total of 28 randomised controlled trials involving 2,131 patients were included. Patients receiving antifibrinolytic agents had a reduced total blood loss by a mean of 389.14 ml (95% CI, -483.05 to -295.23), and the number of blood transfusions per patient by 0.65 units (95% CI, -1.19 to -0.12). Antifibrinolytic agents led to a significant reduction in transfusion requirements (RR 0.55; 95% CI, 0.43 to 0.70) and no increase in the risk of DVT (RR 0.85; 95% CI, 0.51 to 1.42). CONCLUSIONS Our meta-analysis demonstrated that antifibrinolytic agents significantly reduce blood loss and blood transfusion requirements while not increasing the risk of DVT in patients undergoing total hip arthroplasty.
2.
Use of aprotinin to reduce blood loss and transfusion in major orthopedic surgery: a meta-analysis
Huang F, Zhao Q, Guo C, Ma G, Wang Q, Yin Y, Wu Y
Transfusion & Apheresis Science. 2014;51((2):):152-61.
Abstract
BACKGROUD Conflicting reports have been published regarding the effectiveness and safety of aprotinin in reducing blood loss and transfusion in patients undergoing orthopedic surgery. We performed a meta-analysis to evaluate the effectiveness and safety of aprotinin in reducing blood loss and transfusion in major orthopedic surgery. MATERIALS AND METHODS MEDLINE, PubMed, EMBASE and Cochrane databases were searched for relevant studies. Only randomized controlled trials were eligible for this study. The weighted mean difference in blood loss, and number of transfusions per patient and the summary risk ratio of transfusion requirements, and deep-vein thrombosis (DVT) were calculated in the aprotinin-treated group and the control group. RESULTS Eighteen randomized controlled trials involving 1276 patients were included. The use of aprotinin reduced total blood loss by a mean of 498.88ml (95% confidence interval [CI]; -735.03 to -262.72), intra-operative blood loss by a mean of 246.11ml (95% CI; -352.11 to -140.11), post-operative blood loss by a mean of 169.11ml (95% CI; -234.06 to -105.55), the number of blood transfusions per patient by 0.93 units (95% CI; -1.36 to -0.51). Aprotinin led to a signficant reduction in transfusion requirements (RR 0.59; 95% CI; 0.51 to 0.69) and no increase in the risk of DVT (RR 0.58; 95% CI; 0.38 to 1.08). CONCLUSION The meta-analysis shows that aprotinin could significantly reduce blood loss and blood transfusion requirements in patients undergoing orthopedic surgery, and it did not appear to increase the risk of DVT.Copyright 2014 Elsevier Ltd. All rights reserved.
3.
The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: a meta-analysis
Huang F, Wu D, Ma G, Yin Z, Wang Q
Journal of Surgical Research. 2014;186((1):):318-27.
Abstract
BACKGROUND Conflicting reports have been published regarding the effect of tranexamic acid (TXA) on reducing blood loss and transfusion in patients undergoing orthopedic surgery. We performed a meta-analysis to evaluate the effectiveness and safety of TXA treatment in reducing blood loss and transfusion in major orthopedic surgery. MATERIALS AND METHODS MEDLINE, PubMed, EMBASE, and Cochrane databases were searched for relevant studies. Only randomized controlled trials were eligible for this study. The weighted mean difference in blood loss, number of transfusions per patient, and the summary risk ratio of transfusion and deep vein thrombosis (DVT) were calculated in the TXA-treated group and the control group. RESULTS A total of 46 randomized controlled trials involving 2925 patients were included. The use of TXA reduced total blood loss by a mean of 408.33mL (95% confidence interval [CI], -505.69 to -310.77), intraoperative blood loss by a mean of 125.65mL (95% CI, -182.58 to -68.72), postoperative blood loss by a mean of 214.58mL (95% CI, -274.63 to -154.52), the number of blood transfusions per patient by 0.78U (95% CI, -0.19 to -0.37), and the volumes of blood transfusions per patient by 205.33mL (95% CI, -301.37 to -109.28). TXA led to a significant reduction in transfusion requirements (relative risk, 0.51; 95% CI, 0.46-0.56), and no increase in the risk of DVT (relative risk, 1.11; 95% CI, 0.69-1.79). CONCLUSIONS TXA significantly reduced blood loss and blood transfusion requirements in patients undergoing orthopedic surgery, and did not appear to increase the risk of DVT. Crown Copyright 2014. Published by Elsevier Inc. All rights reserved.