Efficiency of tranexamic acid in perioperative blood loss in hip arthroplasty: a systematic literature review and meta-analysis.

INTRODUCTION AND OBJECTIVE Tranexamic acid (TXA) is an antifibrinolytic drug used to reduce bleeding in mortality risk situations such as trauma. Our objective was to conduct a systematic literature review to evaluate the effectiveness and safety of TXA in reducing bleeding in hip arthroplasty. MATERIAL AND METHODS A systematic literature review and meta-analysis of primary studies similar to controlled trials was performed. Literature was searched in MEDLINE, Embase, Cochrane, LILACS, SciELO and Google Scholar. The review was proposed and undertaken by 2 reviewers and the inclusion criteria were: a) patients undergoing arthroplasty for primary unilateral hip replacement; b) comparison of a treatment group with TXA to a control group that received a placebo or no treatment at all, and c) outcome measures, total blood loss, number of patients receiving allogeneic transfusion and/or incidence of thromboembolic complications. The search was restricted to studies published from 1966 to June 2013. RESULTS A total of 16 studies with 246 patients were retrieved for this review. The total blood loss outcome evidenced a weighted mean difference in favor of TXA vs. controls undergoing hip arthroplasty (-0.45 [P<0.001, 95% CI -0.65 to -0.24]). Weighted relative risk was estimated for the allogeneic transfusion requirement outcome, showing a trend in favor the TXA arm, with fewer patients requiring allogeneic transfusion in hip surgery (0.8 [P<0.02, 95% CI 0.57 to 1.11]); however, this trend was not statistically significant. LIMITATIONS There is a noticeable difference in methods for quantifying total blood loss across the studies reviewed. The need for transfusion outcomes are probably not significant taking into account the number of events in the TXA group. CONCLUSIONS TXA can be routinely used to reduce intra- and post-operative blood loss in primary hip arthroplasty.