Tranexamic acid reduces perioperative blood loss and postoperative hemoglobin loss during total ankle arthroplasty: A systematic review and meta-analysis of clinical comparative studies

James J Butler; Ragul Rajivan; Kishore Konar; Utkarsh Anil; Mohammad T Azam; Raymond Walls; John G Kennedy

doi:10.1016/j.jisako.2024.03.009

Tranexamic acid reduces perioperative blood loss and postoperative hemoglobin loss during total ankle arthroplasty: A systematic review and meta-analysis of clinical comparative studies

J ISAKOS. 2024 Mar 21:S2059-7754(24)00054-3. doi: 10.1016/j.jisako.2024.03.009. Online ahead of print.

Authors

James J Butler¹, Ragul Rajivan², Kishore Konar², Utkarsh Anil³, Mohammad T Azam³, Raymond Walls³, John G Kennedy⁴

Affiliations

¹ Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, 10002, USA. Electronic address: jamesjbutler@rcsi.com.
² University of Buckingham, Buckingham, England, MK18 1EG, United Kingdom.
³ Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, 10002, USA.
⁴ Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, 10002, USA. Electronic address: john.kennedy@nyulangone.org.

PMID: 38521460
DOI: 10.1016/j.jisako.2024.03.009

Abstract

Importance: Peri-operative blood loss during joint replacement procedures is a modifiable risk factor that impacts wound complications, hospital stay and total costs. Tranexamic acid (TXA) is an anti-fibrinolytic that has been widely used in orthopedic surgery, but its efficacy in the setting of total ankle arthroplasty (TAA) has not been quantified to date.

Aim: The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of administering TXA in patients undergoing TAA.

Evidence review: The Medline, Embase and Cochrane library databases were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five comparative studies examining blood loss following administration of TXA for patients undergoing TAA were included. The outcome measures of interest were blood loss, reduction in hemoglobin concentration, transfusion requirements, total complications and wound complications.

Findings: In total, 194 patients received TXA and 187 patients did not receive TXA while undergoing TAA. Based on the common-effects model for total blood loss for the TXA group versus control, the standardized mean difference (SMD) was -0.7832 (95% CI, -1.1544, -0.4120; P < 0.0001), in favor of lower total blood loss for TXA. Based on the random-effects model for reduction in hemoglobin for the TXA group versus control, the SMD was -0.9548 (95% CI, -1.7850, -0.1246; P = 0.0242) in favor of lower hemoglobin loss for TXA. Based on the random-effects model for total complications for the TXA group versus control, the risk ratio was 0.512 (95% CI, 0.1588, 1.6512; P = 0.1876), in favor of lower total complications for TXA but this was not statistically significant.

Conclusions: This current review demonstrated that administration of TXA led to a reduction in blood loss and hemoglobin loss without an increased risk of the development of venous thromboembolism in patients undergoing TAA. No difference was observed with respect to total complication rates between the TXA cohort and the control group. TXA appears to be an effective hemostatic agent in the setting of TAA, but further studies are necessary to identify the optimal timing, dosage and route of TXA during TAA.

Level of evidence: III.

Keywords: Anti-fibrinolytic; Intraoperative blood loss; Total ankle arthroplasty; Tranexamic acid.

Publication types

Review