Association of Intravenous Tranexamic Acid and the Risk of Allogenic Blood Transfusion in Revision Hip Arthroplasty: a M
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SURGERY
Association of Intravenous Tranexamic Acid and the Risk of Allogenic Blood Transfusion in Revision Hip Arthroplasty: a Meta-Analysis of 4517 Patients Liang Sun 1,2 & Qian Gao 1 & Yi Feng 1 Accepted: 9 September 2020 # Springer Nature Switzerland AG 2020
Abstract Revision hip arthroplasty (RHA) is associated with high rates of bleeding. Tranexamic acid (TXA) has been widely used in primary hip arthroplasty (PHA) to minimize blood loss and transfusions. This study aimed to evaluate the efficacy and safety of intravenous (IV) TXA in RHA. PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify studies published up to June 2019. Potential studies evaluating the efficacy and safety of IV TXA during RHA were included. Risk ratio (RR) of allogenic blood transfusion (ABT) and venous thromboembolic (VTE) events in TXA and no-TXA groups were calculated. We summarized 7 cohort observational studies (COSs) including 4517 participants. Intravenous TXA had an association with a reduced risk of ABT [pooled RR = 0.578; 95% confidence interval (CI): 0.448 to 0.745] compared with no-TXA cohort in the perioperative period. No significant difference was seen in VTE events (pooled RR = 1.335; 95% CI: 0.586–3.040, P = 0.492) between TXA and no-TXA cohorts. Further subgroup analysis strengthened blood-sparing efficacy of TXA. IV TXA is associated with a lower risk of ABT following RHA, without increasing the risk of VTE. However, due to limited number of COSs, well-designed randomized controlled trials are required to draw concrete conclusions. Keywords Tranexamic acid . Revision hip arthroplasty . Transfusion . Venous thromboembolic events . Meta-analysis
Introduction As the number of patients undergoing primary hip arthroplasties (PHA) steadily increases, and life expectancy of patients turns longer, the number of revision hip arthroplasty (RHA) being undertaken has increased significantly. Usually, overall 5-year rate of RHA ranges from 1.9 to 3.2% [1]. Projections show that case volume of RHA will This article is part of the Topical Collection on Surgery Liang Sun and Qian Gao contributed equally to this work and should be considered co-first authors. * Yi Feng [email protected] 1
Department of Anesthesiology, Peking University People’s Hospital, No.11, Xi Zhi Men Nan Da Jie, Xicheng District, Beijing 100044, China
2
Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
grow by 137% between 2005 and 2030 in the USA [2]. Compared with PHA, due to more insults to soft-tissue and longer surgical time, patients undergoing RHA are highly associated with transfusion to compensate for massive bleeding [3]. Published studies indicated that preoperative and intraoperative allogenic blood transfusion (ABT) has been associated with increased risk of infections and delayed recovery and may increase healthcare costs and burden on resources in PHA patients [4, 5]. Blood-saving techniques, such as the us
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