Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis
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(2020) 15:530
RESEARCH ARTICLE
Open Access
Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis Yimin Zhang1†, Bao Lang2†, Guifeng Zhao3* and Fengming Wang4*
Abstract Background: There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods: Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results: Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions: Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery. Keywords: Total knee replacement, Tourniquets, Tranexamic acid, Hemostasis, Randomized controlled trial
* Correspondence: [email protected]; [email protected] † Yimin Zhang and Bao Lang are co-first authors 3 Medical Department, Weifang People’s Hospital, No. 151, Guangwen Road, Kuiwen District, Weifang 261000, Shandong Province, People’s Republic of China 4 Orthopaedics Department, People’s Hospital of Xiashan Ecological and Economic Development Zone, No. 1, Xiashou Road, Xiashan District, Weifang 261325, Shandong Province, People’s Republic of China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Cre
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