A Meta‐Analysis of Complications of Tranexamic Acid Use in Lower‐Limb Orthopedic Surgery

AORN Journal ◽  
2021 ◽  
Vol 113 (6) ◽  
pp. 657-660
Author(s):  
George Allen
Keyword(s):  
Tranexamic Acid ◽  
Orthopedic Surgery ◽  
Lower Limb ◽  
Meta Analysis

scholarly journals Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Davide Reale ◽  
Luca Andriolo ◽  
Safa Gursoy ◽  
Murat Bozkurt ◽  
Giuseppe Filardo ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Surgical Procedures ◽  
Lower Limb ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Orthopedic Procedures ◽  
Cochrane Library ◽  
Complication Rates ◽  
Administration Route ◽  
Orthopedic Surgical Procedures

Objective. Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss; however, there are concerns about the risk of venous thromboembolic (VTE) complications. The aim of this study was to evaluate TXA safety in patients undergoing lower limb orthopedic surgical procedures. Design. A meta-analysis was performed on the PubMed, Web of Science, and Cochrane Library databases in January 2020 using the following string (Tranexamic acid) AND ((knee) OR (hip) OR (ankle) OR (lower limb)) to identify RCTs about TXA use in patients undergoing every kind of lower limb surgical orthopedic procedures, with IV, IA, or oral administration, and compared with a control arm to quantify the VTE complication rates. Results. A total of 140 articles documenting 9,067 patients receiving TXA were identified. Specifically, 82 studies focused on TKA, 41 on THA, and 17 on other surgeries, including anterior cruciate ligament reconstruction, intertrochanteric fractures, and meniscectomies. The intravenous TXA administration protocol was studied in 111 articles, the intra-articular in 45, and the oral one in 7 articles. No differences in terms of thromboembolic complications were detected between the TXA and control groups neither in the overall population (2.4% and 2.8%, respectively) nor in any subgroup based on the surgical procedure and TXA administration route. Conclusions. There is an increasing interest in TXA use, which has been recently broadened from the most common joint replacement procedures to the other types of surgeries. Overall, TXA did not increase the risk of VTE complications, regardless of the administration route, thus supporting the safety of using TXA for lower limb orthopedic surgical procedures.

Do Antifibrinolytics Reduce Allogeneic Blood Transfusion in Orthopedic Surgery?

2006 ◽  
Vol 105 (5) ◽  
pp. 1034-1046 ◽  
Author(s):  
Paul Zufferey ◽  
Fanette Merquiol ◽  
Silvy Laporte ◽  
Hervé Decousus ◽  
Patrick Mismetti ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Orthopedic Surgery ◽  
Meta Analysis ◽  
Aminocaproic Acid ◽  
Dose Effect ◽  
Controlled Trials ◽  
Erythrocyte Transfusion ◽  
Sufficient Power ◽  
Hip And Knee Arthroplasty ◽  
Epsilon Aminocaproic Acid

Studies have shown that antifibrinolytic (aprotinin, tranexamic acid, epsilon-aminocaproic acid) reduce blood loss in orthopedic surgery. However, most lacked sufficient power to evaluate the efficacy and safety on clinical outcomes. This meta-analysis aims to evaluate whether intravenous antifibrinolytics, when compared with placebo, reduce perioperative allogeneic erythrocyte transfusion requirement in adults undergoing orthopedic surgery and whether it might increase the risk of venous thromboembolism. From MEDLINE, EMBASE, and the Cochrane Controlled Trials Register, the authors identified 43 randomized controlled trials in total hip and knee arthroplasty, spine fusion, musculoskeletal sepsis, or tumor surgery performed to July 2005 (for aprotinin, 23 trials with 1,268 participants; tranexamic acid, 20 with 1,084; epsilon-aminocaproic acid, 4 with 171). Aprotinin and tranexamic acid reduced significantly the proportion of patients requiring allogeneic erythrocyte transfusion according to a transfusion protocol. The odds ratio was 0.43 (95% confidence interval, 0.28-0.64) for aprotinin and 0.17 (0.11-0.24) for tranexamic acid. Results suggest a dose-effect relation with tranexamic acid. Epsilon-aminocaproic acid was not efficacious. Unfortunately, data were too limited for any conclusions regarding safety. Although the results suggest that aprotinin and tranexamic acid significantly reduce allogeneic erythrocyte transfusion, further evaluation of safety is required before recommending the use of antifibrinolytics in orthopedic surgery.

Tranexamic Acid in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Joanna C. Dionne ◽  
Simon JW Oczkowski ◽  
Beverley J. Hunt ◽  
Massimo Antonelli ◽  
Marije Wijnberge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Bleeding ◽  
Tranexamic Acid ◽  
Meta Analysis

Effect of Tranexamic Acid in Subarachnoid Haemorrhage. A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Jean-Baptiste Bouillon-Minois ◽  
Carolyne Croizier ◽  
Julien S. Baker ◽  
Farès Moustafa ◽  
Jeannot Schmidt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Haemorrhage ◽  
Tranexamic Acid ◽  
Meta Analysis
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