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Scientific Articles   |    
Effectiveness and Safety of Tranexamic Acid in Reducing Blood Loss in Total Knee Arthroplasty: A Meta-Analysis
Zhi-Gao Yang, MD1; Wei-Ping Chen, MD1; Li-Dong Wu, PhD, MD1
1 Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jie Fang Road, Hangzhou, Zhejiang Province, 310009, The People’s Republic of China. E-mail address for L.-D. Wu: ldwu@yahoo.com
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jie Fang Road, Hangzhou, Zhejiang Province, 310009, The People’s Republic of China. E-mail address for L.-D. Wu: ldwu@yahoo.com
Investigation performed at the Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, The People’s Republic of China

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jul 03;94(13):1153-1159. doi: 10.2106/JBJS.K.00873
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Abstract

Background: 

Total knee arthroplasty is associated with substantial blood loss and the risks of transfusion. Conflicting reports have been published regarding the effectiveness and safety of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty. We performed a meta-analysis to investigate the effectiveness and safety of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty.

Methods: 

A meta-analysis was performed to assess the effectiveness and safety of using tranexamic acid in total knee arthroplasty. Randomized controlled trials that had been published before May 2011 were retrieved, and fifteen studies met the inclusion criteria. The weighted mean difference in blood loss, number of transfusions per patient, prothrombin time, and postoperative activated partial thromboplastin time and the summary odds ratio of transfusion, deep-vein thrombosis, and pulmonary embolism were calculated in the group of patients who received tranexamic acid and the group of patients who received a placebo.

Results: 

The amount of blood loss and the number of blood transfusions per patient were significantly less and the proportion of patients who required a blood transfusion was smaller in the tranexamic acid group compared with the placebo group. No significant difference in prothrombin time, activated partial thromboplastin time, deep-vein thrombosis, and pulmonary embolism was detected between the tranexamic acid group and the placebo group.

Conclusions: 

The meta-analysis shows that the use of tranexamic acid for patients undergoing total knee arthroplasty is effective and safe for the reduction of blood loss.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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