Topical administration of tranexamic acid in total hip arthroplasty: a Meta-analysis_West China Medical Journal

Authors：

 LIU Kai , ZHANG Huiwei , WANG Yongcai , WANG Zerong , MA Liqun , WANG Hongchuan

Department of Orthopedics, People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding?author：

LIU Kai, Email: 285061643@qq.com

Keywords：

Tranexamic acid; Topical administration; Total hip arthroplasty; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1002-0179.201606225

Video：

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Objective To systematically review the clinical efficiency and safety after topical administration of tranexamic acid in total hip arthroplasty. Methods Relevant randomized controlled trials were identified from databases such as Cochrane Library, PubMed, Embase and CNKI from the establishment of the database to August, 2017. A systematic review was performed to compare total blood loss, the rate of transfusion and thromboembolism events between the tranexamic acid group and the control group. And the patients in tranexamic acid group were treated with tranexamic acid for hemorrhage after total hip arthroplasty, while the patients in the control group were not treated with tranexamic acid or used isotonic saline. Analysis was carried out using Review Manager version 5.2.0 software. Results Eight studies were incorporated into the Meta-analysis. The results of Meta-analysis showed that there was significant difference in total blood loss between two groups [weighted mean difference (WMD)=–360.27 mL, 95% confidence interval (CI) (–412.68, –307.87) mL, P<0.000 01]. There was significant difference in the rate of transfusion between two groups [ (odds ratio,OR)=0.22, 95%CI (0.14, 0.33), P<0.000 01]. There was no significant difference in complications between two groups [OR=1.48, 95%CI (0.41, 5.34), P=0.55]. Conclusion Topical administration of tranexamic acid could significantly reduce total blood loss and transfusion requirements in primary total hip arthroplasty, and would not increase thromboembolic complications.

Citation： LIU Kai, ZHANG Huiwei, WANG Yongcai, WANG Zerong, MA Liqun, WANG Hongchuan. Topical administration of tranexamic acid in total hip arthroplasty: a Meta-analysis. West China Medical Journal, 2017, 32(10): 1493-1498. doi: 10.7507/1002-0179.201606225 Copy

1.	Watts CD, Pagnano MW. Minimising blood loss and transfusion in contemporary hip and knee arthroplasty. J Bone Joint Surg Br, 2012, 94(11 Suppl A): 8-10.
2.	Panteli M, Papakostidis C, Dahabreh Z, et al. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee, 2013, 20(5): 300-309.
3.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0. (2011-03-01)[2016-10-01]. http://www.Cochrane-handbook.org.
4.	Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty, 2013, 28(9): 1473-1476.
5.	Alshryda S, Mason J, Vaghela M, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H). J Bone Joint Surg Am, 2013, 95(21): 1969-1974.
6.	Martin JG, Cassatt KB, Kincaid-Cinnamon KA, et al. Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplasty, 2014, 29(5): 889-894.
7.	Yue C, Kang P, Yang P, et al. Topical application of tranexamic acid in primary total hip arthroplasty: a randomized double-blind controlled trial. J Arthroplasty, 2014, 29(12): 2452-2456.
8.	Wei W, Wei B. Comparison of topical and intravenous tranexamic acid on blood loss and transfusion rates in total hip arthroplasty. J Arthroplasty, 2014, 29(11): 2113-2116.
9.	殷晗, 王大偉, 馬文譜, 等. 經引流管逆行注入氨甲環酸降低初次全髖置換術后失血量的有效性及近期安全性評估. 中華關節外科雜志: 電子版, 2014, 8(5): 669-672.
10.	凡福成, 桂斌捷. 髖關節置換后氨甲環酸關節腔注射及間斷夾管: 出血量的變化. 中國組織工程研究, 2014, 18(40): 6397-6402.
11.	葉嘉靖, 陳忠義, 江玲軍, 等. 局部應用氨甲環酸對全髖關節置換術術后失血量及功能的影響. 醫藥, 2015(3): 212-213.
12.	Ishida K, Tsumura N, Kitagawa A, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop, 2011, 35(11): 1639-1645.
13.	Gilbody J, Dhotar HS, Perruccio AV, et al. Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty. J Arthroplasty, 2014, 29(4): 681-684.
14.	Sukeik M, Alshryda S, Haddad FS, et al. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br, 2011, 93B(1): 39-46.
15.	Wong J, Abrishami A, El Beheiry H, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg, 2010, 92(15): 2503-2513.

1. Watts CD, Pagnano MW. Minimising blood loss and transfusion in contemporary hip and knee arthroplasty. J Bone Joint Surg Br, 2012, 94(11 Suppl A): 8-10.
2. Panteli M, Papakostidis C, Dahabreh Z, et al. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee, 2013, 20(5): 300-309.
3. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0. (2011-03-01)[2016-10-01]. http://www.Cochrane-handbook.org.
4. Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty, 2013, 28(9): 1473-1476.
5. Alshryda S, Mason J, Vaghela M, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H). J Bone Joint Surg Am, 2013, 95(21): 1969-1974.
6. Martin JG, Cassatt KB, Kincaid-Cinnamon KA, et al. Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplasty, 2014, 29(5): 889-894.
7. Yue C, Kang P, Yang P, et al. Topical application of tranexamic acid in primary total hip arthroplasty: a randomized double-blind controlled trial. J Arthroplasty, 2014, 29(12): 2452-2456.
8. Wei W, Wei B. Comparison of topical and intravenous tranexamic acid on blood loss and transfusion rates in total hip arthroplasty. J Arthroplasty, 2014, 29(11): 2113-2116.
9. 殷晗, 王大偉, 馬文譜, 等. 經引流管逆行注入氨甲環酸降低初次全髖置換術后失血量的有效性及近期安全性評估. 中華關節外科雜志: 電子版, 2014, 8(5): 669-672.
10. 凡福成, 桂斌捷. 髖關節置換后氨甲環酸關節腔注射及間斷夾管: 出血量的變化. 中國組織工程研究, 2014, 18(40): 6397-6402.
11. 葉嘉靖, 陳忠義, 江玲軍, 等. 局部應用氨甲環酸對全髖關節置換術術后失血量及功能的影響. 醫藥, 2015(3): 212-213.
12. Ishida K, Tsumura N, Kitagawa A, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop, 2011, 35(11): 1639-1645.
13. Gilbody J, Dhotar HS, Perruccio AV, et al. Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty. J Arthroplasty, 2014, 29(4): 681-684.
14. Sukeik M, Alshryda S, Haddad FS, et al. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br, 2011, 93B(1): 39-46.
15. Wong J, Abrishami A, El Beheiry H, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg, 2010, 92(15): 2503-2513.

West China Medical Journal

Topical administration of tranexamic acid in total hip arthroplasty: a Meta-analysis

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