Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2017

14.07.2016 | Knee

Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis

verfasst von: Young-Soo Shin, Jung-Ro Yoon, Hoon-Nyun Lee, Se-Hwan Park, Dae-Hee Lee

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 11/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This meta-analysis was designed to compare the effectiveness and safety of intravenous (IV) versus topical administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty (TKA) by evaluating the need for allogenic blood transfusion, incidence of postoperative complications, volume of postoperative blood loss, and change in haemoglobin levels.

Methods

Studies were included in this meta-analysis to check whether they assessed the allogenic blood transfusion rate, postoperative complications including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT), volume of postoperative blood loss via drainage, estimated blood loss, total blood loss, and change in haemoglobin levels before and after surgery in primary TKA with TXA administered through both the IV and topical routes.

Results

Ten studies were included in this meta-analysis. The proportion of patients requiring allogenic blood transfusion (OR 1.34, 95 % CI 0.63–2.81; n.s.) and the proportion of patients who developed postoperative complications including PTE or DVT (OR 0.85, 95 % CI 0.41 to 1.77; n.s.) did not significantly differ between the two groups. There was 52.3 mL less blood loss via drainage (95 % CI −50.74 to 185.66 mL; n.s.), 52.1 mL greater estimated blood loss (95 % CI −155.27 to 51.03 mL; n.s.), and 51.4 mL greater total blood loss (95 % CI −208.16 to 105.31 mL; n.s.) in the topical TXA group as compared to the IV TXA group. The two groups were also similar in terms of the change in haemoglobin levels (0.02 g/dL, 95 % CI −0.36 to 0.39 g/dL; n.s.).

Conclusions

In primary TKA, there are no significant differences in the transfusion requirement, postoperative complications, blood loss, and change in haemoglobin levels between the IV and topical administration of TXA. In addition, results from subgroup analysis evaluating the effect of the times of TXA administration through the IV route suggested that double IV dose of TXA is more effective than single dose in terms of the transfusion requirements and blood loss via drainage. The current meta-analysis indicates that IV administration of 10 mg/kg of TXA 20 min before inflation of the tourniquet followed by 10 mg/kg of TXA 15 min before deflation of the tourniquet is effective and safe. The topical administration of 2 g of TXA mixed with 100 mL of normal saline after wound closure could be an alternative option in patients at greater risk of thromboembolic complications.

Level of evidence

Meta-analysis, Level III.
Literatur
1.
Zurück zum Zitat Aglietti P, Baldini A, Vena LM, Abbate R, Fedi S, Falciani M (2000) Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res 371:169–177CrossRef Aglietti P, Baldini A, Vena LM, Abbate R, Fedi S, Falciani M (2000) Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res 371:169–177CrossRef
2.
Zurück zum Zitat Aguilera X, Martínez-Zapata MJ, Hinarejos P et al (2015) Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial. Arch Orthop Trauma Surg 135:1017–1025CrossRefPubMed Aguilera X, Martínez-Zapata MJ, Hinarejos P et al (2015) Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial. Arch Orthop Trauma Surg 135:1017–1025CrossRefPubMed
3.
Zurück zum Zitat Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM (2011) Tranexamic acid in total knee replacement a systematic review and meta-analysis. J Bone Joint Surg Br 93:1577–1585CrossRefPubMed Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM (2011) Tranexamic acid in total knee replacement a systematic review and meta-analysis. J Bone Joint Surg Br 93:1577–1585CrossRefPubMed
4.
Zurück zum Zitat Benoni G, Lethagen S, Fredin H (1997) The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty. Thromb Res 85(3):195–206CrossRefPubMed Benoni G, Lethagen S, Fredin H (1997) The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty. Thromb Res 85(3):195–206CrossRefPubMed
5.
6.
Zurück zum Zitat Charoencholvanich K, Siriwattanasakul P (2011) Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res 469:2874–2880CrossRefPubMedPubMedCentral Charoencholvanich K, Siriwattanasakul P (2011) Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res 469:2874–2880CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Freedman J, Luke K, Monga N et al (2005) A provincial program of blood conservation: the Ontario Transfusion Coordinators (ONTraC). Transfus Apher Sci 33:343–349CrossRefPubMed Freedman J, Luke K, Monga N et al (2005) A provincial program of blood conservation: the Ontario Transfusion Coordinators (ONTraC). Transfus Apher Sci 33:343–349CrossRefPubMed
8.
Zurück zum Zitat Gillette BP, DeSimone LJ, Trousdale RT, Pagnano MW, Sierra RJ (2013) Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty. Clin Orthop Relat Res 471:150–154CrossRefPubMed Gillette BP, DeSimone LJ, Trousdale RT, Pagnano MW, Sierra RJ (2013) Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty. Clin Orthop Relat Res 471:150–154CrossRefPubMed
9.
Zurück zum Zitat Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R (2014) Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement. J Bone Joint Surg Am 96:1937–1944CrossRefPubMed Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R (2014) Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement. J Bone Joint Surg Am 96:1937–1944CrossRefPubMed
10.
Zurück zum Zitat Good L, Peterson E, Lisander B (2003) Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 90:596–599CrossRefPubMed Good L, Peterson E, Lisander B (2003) Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 90:596–599CrossRefPubMed
11.
Zurück zum Zitat Griffin D, Parson N, Shaw E et al (2014) Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 349:g4483CrossRefPubMedPubMedCentral Griffin D, Parson N, Shaw E et al (2014) Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 349:g4483CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Hamlin BR, Digioia AM, Plakseychuk AY, Levison TJ (2015) Topical versus intravenous tranexamic acid in total knee arthroplasty. J Arthroplasty 30:384–386CrossRefPubMed Hamlin BR, Digioia AM, Plakseychuk AY, Levison TJ (2015) Topical versus intravenous tranexamic acid in total knee arthroplasty. J Arthroplasty 30:384–386CrossRefPubMed
13.
Zurück zum Zitat Hegde C, Wasnik S, Kulkarni S, Pradhan S, Shetty V (2013) Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty 28:1888–1891CrossRefPubMed Hegde C, Wasnik S, Kulkarni S, Pradhan S, Shetty V (2013) Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty 28:1888–1891CrossRefPubMed
14.
Zurück zum Zitat Hinarejos P, Corrales M, Matamalas A, Bisbe E, Cáceres E (2009) Computer-assisted surgery can reduce blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:356–360CrossRefPubMed Hinarejos P, Corrales M, Matamalas A, Bisbe E, Cáceres E (2009) Computer-assisted surgery can reduce blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:356–360CrossRefPubMed
15.
Zurück zum Zitat Kim TK, Chang CB, Koh IJ (2014) Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 22:1849–1858CrossRefPubMed Kim TK, Chang CB, Koh IJ (2014) Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 22:1849–1858CrossRefPubMed
16.
Zurück zum Zitat Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR (2012) Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 470:2605–2612CrossRefPubMedPubMedCentral Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR (2012) Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 470:2605–2612CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Moonen AF, Neal TD, Pilot P (2006) Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature. Injury 37:S11–S16CrossRefPubMed Moonen AF, Neal TD, Pilot P (2006) Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature. Injury 37:S11–S16CrossRefPubMed
18.
Zurück zum Zitat Mutsuzaki H, Ikeda K (2012) Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty. J Orthop Surg Res 7:32CrossRefPubMedPubMedCentral Mutsuzaki H, Ikeda K (2012) Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty. J Orthop Surg Res 7:32CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Nuttall GA, Brost BC, Connis RT et al (2006) Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 105:198–208CrossRef Nuttall GA, Brost BC, Connis RT et al (2006) Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 105:198–208CrossRef
20.
Zurück zum Zitat Orpen NM, Little C, Walker G, Crawfurd EJ (2006) Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee 13:106–110CrossRefPubMed Orpen NM, Little C, Walker G, Crawfurd EJ (2006) Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee 13:106–110CrossRefPubMed
21.
Zurück zum Zitat Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV (2013) Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 20:300–309CrossRefPubMed Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV (2013) Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 20:300–309CrossRefPubMed
22.
Zurück zum Zitat Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL (2014) Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty 29:1528–1531CrossRefPubMed Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL (2014) Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty 29:1528–1531CrossRefPubMed
23.
Zurück zum Zitat Sa-Ngasoongsong P, Wongsak S, Chanplakorn P et al (2013) Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial. BMC Musculoskelet Disord 14:340CrossRefPubMedPubMedCentral Sa-Ngasoongsong P, Wongsak S, Chanplakorn P et al (2013) Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial. BMC Musculoskelet Disord 14:340CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Sarzaeem MM, Razi M, Kazemian G, Moghddam ME, Rasi AM, Karimi M (2014) Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty. J Arthroplasty 29:1521–1524CrossRefPubMed Sarzaeem MM, Razi M, Kazemian G, Moghddam ME, Rasi AM, Karimi M (2014) Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty. J Arthroplasty 29:1521–1524CrossRefPubMed
25.
Zurück zum Zitat Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty?: correct blood loss management should take hidden loss into account. Knee 7:151–155CrossRefPubMed Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty?: correct blood loss management should take hidden loss into account. Knee 7:151–155CrossRefPubMed
26.
Zurück zum Zitat Seo JG, Moon YW, Park SH, Kim SM, Ko KR (2013) The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:1869–1874CrossRefPubMed Seo JG, Moon YW, Park SH, Kim SM, Ko KR (2013) The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:1869–1874CrossRefPubMed
27.
Zurück zum Zitat Shemshaki H, Nourian SM, Norian N, Dehghani M, Mokhtari M, Mazoochian F (2015) One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Arch Orthop Trauma Surg 135:573–588CrossRefPubMed Shemshaki H, Nourian SM, Norian N, Dehghani M, Mokhtari M, Mazoochian F (2015) One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Arch Orthop Trauma Surg 135:573–588CrossRefPubMed
28.
Zurück zum Zitat Soni A, Saini R, Gulati A, Paul R, Bhatty S, Rajoli SR (2014) Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty. J Arthroplasty 29:1525–1527CrossRefPubMed Soni A, Saini R, Gulati A, Paul R, Bhatty S, Rajoli SR (2014) Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty. J Arthroplasty 29:1525–1527CrossRefPubMed
29.
Zurück zum Zitat Wang H, Shen B, Zeng Y (2014) Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. Knee 21:987–993CrossRefPubMed Wang H, Shen B, Zeng Y (2014) Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. Knee 21:987–993CrossRefPubMed
30.
Zurück zum Zitat Wei Z, Liu M (2015) The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty: a meta-analysis of 2720 cases. Transfus Med 25:151–162CrossRefPubMed Wei Z, Liu M (2015) The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty: a meta-analysis of 2720 cases. Transfus Med 25:151–162CrossRefPubMed
32.
Zurück zum Zitat Wind TC, Barfield WR, Moskal JT (2013) The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty. J Arthroplasty 28:1080–1083CrossRefPubMed Wind TC, Barfield WR, Moskal JT (2013) The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty. J Arthroplasty 28:1080–1083CrossRefPubMed
33.
Zurück zum Zitat Yang Y, Lv YM, Ding PJ, Li J, Ying-Ze Z (2015) The reduction in blood loss with intra-articular injection of tranexamic acid in unilateral total knee arthroplasty without operative drains: a randomized controlled trial. Eur J Orthop Surg Traumatol 25:135–139CrossRefPubMed Yang Y, Lv YM, Ding PJ, Li J, Ying-Ze Z (2015) The reduction in blood loss with intra-articular injection of tranexamic acid in unilateral total knee arthroplasty without operative drains: a randomized controlled trial. Eur J Orthop Surg Traumatol 25:135–139CrossRefPubMed
34.
Zurück zum Zitat Zanasi S (2011) Innovations in total knee replacement: new trends in operative treatment and changes in peri-operative management. Eur Orthop Traumatol 2:21–31CrossRefPubMedPubMedCentral Zanasi S (2011) Innovations in total knee replacement: new trends in operative treatment and changes in peri-operative management. Eur Orthop Traumatol 2:21–31CrossRefPubMedPubMedCentral
Metadaten
Titel
Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis
verfasst von
Young-Soo Shin
Jung-Ro Yoon
Hoon-Nyun Lee
Se-Hwan Park
Dae-Hee Lee
Publikationsdatum
14.07.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 11/2017
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4235-6

Weitere Artikel der Ausgabe 11/2017

Knee Surgery, Sports Traumatology, Arthroscopy 11/2017 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.