Background
Methods
Search strategy
Inclusion criteria
Exclusive criteria
Selection criteria
Quality assessment
Data extraction
Data analysis and statistical methods
Results
Search results
Risk of bias assessment
Study characteristics
Study | Operation | Cases (A/C) | Mean age (A/C) | Gender (F) | Dosage | Prophylactic anticoagulant | Transfusion trigger |
---|---|---|---|---|---|---|---|
Camarasa et al. 2006 | TKA | 32/60 | 73/72 | 28/48 | 100 mg/kg administered intravenously in 30 min (before tourniquet release) + 3 g for 3 h following first dose | LMWH | Hb < 8 g/dl or 10 g/dl with clinical symptoms |
Churchill et al. 2017 | TKA | 820/1492 | 63.9/63.9 | 527/956 | 5 g (BW < 50 kg); 10 g (BW > 50 kg) administered intravenously near the time of tourniquet release | Surgeon’s discretion | NS |
Churchill et al. 2016 (THA) | THA | 911/643 | 65.1/65.4 | 392/377 | 5 g (BW < 50 kg); 10 g (BW > 50 kg) administered intravenously near the time of incision | Surgeon’s discretion | Surgeon’s discretion |
Churchill et al. 2016 (TKA) | TKA | 25/25 | 65.2/66.6 | 21/15 | 10 g administered intravenously over 10 min and was completely infused before tourniquet deflation | Warfarin | Hb < 7 g/dl or 9 g/dl with clinical symptoms |
Harley et al. 2002 | THA | 26/29 | 69/69 | 16/18 | 150 mg/kg administered intravenously over 20 min on the patient’s arrival in the operating room + 12.5 mg/kg/h for an additional 5 h | Heparin | Hb < 80 g/L or HCT < 0.24 or patients having anemia symptoms |
Hobbs et al. 2017 | THA and TKA | 184/185 | 62.1/63.1 | 14/14 | 5 g administered intravenously over 20 min before incision + 5 g again during closure | Asprin, LMWH | Surgeon’s discretion |
Ray et al. 2005 | THA | 15/15 | 72/69 | NS | 10 g administered intravenously over 30 min after the induction of anesthesia + 5 g over 3 h | Aspirin | NS |
Quality assessment for non-randomized trials | Churchill et al. 2016 (THA) | Churchill et al. 2016 (TKA) | Churchill et al. 2017 | Hobbs et al. 2017 |
---|---|---|---|---|
A clearly stated aim | 2 | 2 | 2 | 2 |
Inclusion of consecutive patients | 2 | 2 | 2 | 2 |
Prospective data collection | 0 | 0 | 0 | 0 |
Endpoints appropriate to the aim of the study | 2 | 2 | 2 | 2 |
Unbiased assessment of the study endpoint | 2 | 2 | 2 | 2 |
A follow-up period appropriate to the aims of study | 2 | 2 | 2 | 2 |
Less than 5% loss to follow-up | 2 | 2 | 2 | 2 |
Prospective calculation of the sample size | 0 | 0 | 0 | 0 |
An adequate control group | 2 | 2 | 2 | 2 |
Contemporary groups | 2 | 2 | 2 | 0 |
Baseline equivalence of groups | 2 | 2 | 2 | 2 |
Adequate statistical analyses | 2 | 2 | 2 | 2 |
Total score | 20 | 20 | 20 | 18 |
Outcome of subgroup | Studies | Effect estimate | ||||
---|---|---|---|---|---|---|
χ
2
| I2 (%) | RD | 95% CI | P value | ||
TKA | 3 | 13.34 | 88 | − 0.22 | [− 0.42, − 0.02] | 0.03 |
THA | 3 | 3.20 | 38 | − 0.17 | [− 0.21, − 0.13] | 0.00001 |
Transfusion trigger | 3 | 4.47 | 57 | − 0.23 | [− 0.35, − 0.12] | 0.0001 |
Continuous application | 4 | 4.88 | 39 | − 0.20 | [− 0.26, − 0.14] | 0.00001 |