Reduced blood loss after intra-articular tranexamic acid injection during total knee arthroplasty: a meta-analysis of the literature

Purpose

The purpose of the study is to conduct a meta-analysis of randomized, controlled trials evaluating the efficacy and safety of intra-articular injection of tranexamic acid (TXA) for reducing blood loss and transfusion in patients undergoing total knee arthroplasty (TKA).

Methods

A meta-analysis was conducted of RCTs published before March 2013, identified from the PubMed, EMBase, Cochrane library, ScienceDirect, and other databases. Two independent reviewers assessed the methodological quality of the studies and performed data extraction. Mean difference in blood loss and blood transfusions, risk ratios of transfusion rates, and deep vein thrombosis (DVT) incidence in the TXA-treated group versus placebo group were pooled from the included studies. Data were analysed using Stata 11.0 software.

Results

Six studies were included, with a total sample size of 647 patients. The use of TXA significantly reduced total blood loss (mean difference: −344.96; 95 % confidence interval (CI) −401.20 to −239.68; P < 0.01) and the proportion of patients requiring blood transfusions (risk ratios, 0.28; 95 % CI: 0.19–0.42; P < 0.01). There were no significant differences in the incidence of DVT, pulmonary embolism, or other complications between the study groups.

Conclusions

The present meta-analysis indicated that intra-articular injection of TXA in patients undergoing TKA may reduce total blood loss and the need for blood transfusions, particularly when a high dosage of TXA is used (≥30 mg/ml), without any increase in the risk of post-operative DVT.

Level of evidence

II.