Combined application versus topical and intravenous application of tranexamic acid following primary total hip arthroplasty: a meta-analysis

BMC Musculoskeletal Disorders

Research Article

Pei Zhang¹  Jingcheng Wang²  Yongchao Fang³  Pengtao Chen³  Yuan Liang³  Jinshan He⁴ 

[1] Dalian Medical University, 116044, Dalian, Liaoning, China;Dalian Medical University, 116044, Dalian, Liaoning, China;Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People’s Hospital, Nantong West Road 98, 225001, Yangzhou, China;Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People’s Hospital of Jiangsu Province, Yangzhou, China;Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People’s Hospital, Nantong West Road 98, 225001, Yangzhou, China;Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People’s Hospital, Nantong West Road 98, 225001, Yangzhou, China;Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People’s Hospital of Jiangsu Province, Yangzhou, China;

关键词: Pulmonary Embolism;    Total Knee Arthroplasty;    Deep Vein Thrombosis;    Rivaroxaban;    Thrombotic Event;   

DOI  :  10.1186/s12891-017-1429-0

 received in 2016-09-17, accepted in 2017-01-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe use of intravenous (IV) or topical tranexamic acid (TXA) in total hip arthroplasty has been proven to be effective and safe in total hip arthroplasty. However, which of these two administration routes is better has not been determined. The combined administration of TXA has been used in total knee arthroplasty with satisfactory results. We hypothesized that combined application of TXA may be the most effective way without increased rate of thrombotic events such as deep vein thrombosis (DVT) and pulmonary embolisms (PE) in patients subjected to primary total hip replacement (THA). A meta-analysis was conducted to compare the efficacy and safety of the combined use of tranexamic acid (TXA) relative to topical or intravenous (IV) use alone for treatment of primary THA. The outcomes included total blood loss, postoperative hemoglobin decline, transfusion rates, and the incidence rates of deep vein thrombosis (DVT) and pulmonary embolisms (PE).MethodsWe searched electronic databases including PubMed, EMBASE, the Cochrane Library, Web of Science, the Chinese Biomedical Literature database, the CNKI database, and Wanfang Data until September 2016. The references of the included articles were also checked for additional potentially relevant studies. There were no language restrictions for the search. The data of the included studies were analyzed using RevMan 5.3 software.ResultsSeven studies met the inclusion criteria, encompassing a total of 1762 patients. Our meta-analysis demonstrated that total blood loss, postoperative hemoglobin decline, and transfusion rates were significantly lower for patients that received the combined treatment compared to patients that received either topical or intravenous administration of TXA. No statistical differences were found in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE).ConclusionThe group that received the combined treatment had lower total blood loss, postoperative hemoglobin decline, and transfusion rates without an increased rate of thrombotic events (DVT or PE). The topical or intravenous use of TXA in primary THA is generally considered to be safe and effective. This meta-analysis demonstrated that combined TXA application may be superior to topical or intravenous application of TXA alone. However, larger, high-quality randomized control trials are required for greater confidence in this finding.

【 授权许可】

CC BY   
© The Author(s). 2017