Table 8.

Orthopedic Surgery

Gandhi and Evans [56]	Meta-analysis	Patients underwent primary unilateral TKA or THA. Study comparisons of TXA to placebo or no treatment. Mean overall blood loss favored TXA over control for TKA (−1.149)(p < 0.001) and THA (−0.504)(p <0.001). Transfusion requirements were decreased as well as no increased incidence of DVT in TKA or THA with TXA use. Authors conclude routine use of TXA in TKA and THA to decrease blood loss
Wind and Barfield [57]	Retrospective database review, 2013	Patients received TXA via infusion, topical application, or neither and the need for transfusion. TXA infusion produced a statistically significant decrease in transfusion rate (p < 0.001). Transfusion rate with TXA (4.39%) without TXA (19.86%) and topical TXA (12.86%) (1494 patients)
Poeran and Rasul [58]	Retrospective cohort, 2014	Intervention of TXA by dose (none, ≤ 1000 mg, 2000 mg, ≥ 3000 mg.) Patients receiving TXA had significantly lower transfusion rates while not increasing the rate of thromboembolic events and acute renal failure across all dosing ranges. (872,416 patients)
Yang and Li [59]	Meta-analysis or RCTs, 2013	581 Patients undergoing mainly scoliosis surgery according to the Cochrane Collaboration Guidelines. TXA was given IV in various dosing regimens. Patients also received Amicar as a comparator as well as placebo. Overall, those treated with TXA who required blood transfusions were decreased by 35% than those treated with Amicar and placebo. A dose independent effect of TXA was also observed. They found blood loss was significantly decreased as well as transfusion requirement in the TXA treated group.
Oremus and Sustaric [60]	RCT, 2014	98 Patients underwent TKA or THA. Patients randomized to TXA (1 gram followed by 1 gram 3 hours later) or saline placebo. Proportion of patients receiving autologous blood reinfusion was lower in the TXA group than placebo, absolute difference of −75.5%. No differences in homologous transfusions and hematologic variables between groups. Authors conclude that with a blood salvage protocol and the addition of TXA a post-operative blood salvage system in unnecessary.
Dahuja and Dahuja [61]	Prospective cohort, 2014	60 Patients with primary osteoarthritis of both knees undergoing staged bilateral TKA at an interval of 3 weeks that had previously received TXA for the first procedure. Used as own controls. TXA 15 mg/kg given before tourniquet and then every 8 hours for 2 days. Total post-operative drain output lower in the TXA group. Hematocrit and platelet count were similar. No thromboembolic events in both groups. TXA treated patients showed no bleeding tendency and increased fibrinogen levels.