Table 3.
Studies using tranexamic acid in hip and knee arthroplasties
| Study | Study design | Patients | TEA dose | Blood loss | Transfusion | Risk of VTE | Unique features of study |
|---|---|---|---|---|---|---|---|
| Johansson et al. [10] (2005) | Double-blind RCT | 100 THA | 15 mg/kg | Reduced blood loss | Reduced transfusion requirements | No VTE complications | Cost-effective: saving 47 euros per patient |
| Niskanen and Korkala [17] (2005) | Double-blind RCT | 39 cemented THA | 10 mg/kg and two 8-hour intervals afterward | Reduced blood loss | Reduced transfusion requirements | No VTE complications | Cost effective |
| Cid and Lozano [4] (2005) | Meta-analysis (9 RCTs through 2004) | 9 RCTs for TKA | Low dose (15–35 mg/kg) High dose (135–150 mg/kg) | Reduced the number of patients requiring RBC | 10X reduction in the risk of having transfusion if TEA administered | 8 of 9 studies reported use of DVT prophylaxis; no analysis of DVT rates between groups | Only in TKA |
| Gill and Rosenstein [8] (2006) | Meta-analysis | 13 RCTs for THA | 10–19 mg/kg with or without infusion of 1 mg/kg/hour | Reduced intraoperative and total blood loss | Only trend toward reduction in RBC transfusion requirements | No difference in VTE rate compared with placebo | Primary and revision THA; compared with aprotinin |
| Orpen et al. [18] (2006) | Double-blind RCT | 29 TKA | 15 mg/kg | Reduced blood loss in early postoperative period | Not powered to show difference in transfusion requirements | No evidence of DVT with duplex ultrasound | Use of set transfusion trigger of 9 g/dL |
| Camarasa et al. [3] (2006) | Double-blind RCT | 127 TKA | 10 mg/kg and 3 hours later | Reduced blood loss | Reduced transfusion rate by nearly 80% | No VTE identified by clinical assessment | Only in TKA |
| Molloy et al. [15] (2007) | RCT | 150 TKA | 500 mg 5 minutes before tourniquet and 3 hours later | Reduced blood loss compared with control group | Reduced transfusion requirements compared with control group | No VTE identified by clinical assessment in TEA group | Dosing not by weight; compared with fibrin glue |
| Claeys et al. [5] (2007) | Double-blind RCT | 40 THA | 15 mg/kg | Reduced total blood loss | Reduced RBC transfusion requirements | Higher DVT by ultrasound in TEA group | None |
| Alvarez et al. [1] (2008) | Double-blind RCT | 95 TKA | 10 mg/kg, then 1 mg/kg/hour infusion | 25% reduction in total blood loss | Reduced RBC transfusion requirements | No VTE seen in either study group | Combined with an active perioperative blood conservation program |
| Lozano et al. [13] (2008) | Retrospective trial | 414 TKA | 10 mg/kg before and after tourniquet | Reduced perioperative blood loss in TEA group | Reduced RBC transfusions | No increase in VTE using contrast venography | Transfusion costs reduced |
| Rajesparan et al. [19] (2009) | Retrospective study | 73 THA | 1 g IV at induction | Estimated total mean actual blood loss was less | Reduced RBC transfusion requirements | No increased incidence of DVT | Dose at discretion of surgeon |
| Kagoma et al. [12] (2009) | Meta-analysis (1966–2007) | 29 RCTs for THA and TKA | 10–15 mg/kg | Reduced blood loss | Reduced transfusion requirements | No difference in VTE rates between groups | Also compared EACA and aprotinin |
| Current study | Retrospective cohort | 493 THA and TKA | 20 mg/kg | Reduced blood loss | Reduced RBC transfusion requirements | No difference in VTE rates between groups | Clinically acceptable regimen for THA and TKA |
VTE = venous thromboembolic event; RCT = randomized control trial; RBC = red blood cell; TEA = tranexamic acid; DVT = deep vein thrombosis; EACA = epsilon-aminocaproic acid.