The Efficacy and Safety of Tranexamic Acid in Revision Total Knee and Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND

This study evaluated 3 key aspects of tranexamic acid (TXA) use following revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA): 1) its efficacy, including changes in hemoglobin, blood loss, blood transfusions, and red blood cell transfusions; 2) its safety, specifically venous thromboembolism including pulmonary embolism and deep vein thrombosis; and 3) the role of TXA administration, including the dose and route.

METHODS

A comprehensive search was conducted across PubMed, Scopus, Cochrane Cochrane Central Register of Controlled Trials, Embase, and Web of Science through 2024. Studies comparing TXA treatment to non-TXA treatment in patients undergoing rTHA or rTKA were included.

RESULTS

Our study included 27 studies with 10,248 patients (4700 in the TXA group and 5548 in the non-TXA group). A total of 25 studies were subjected to meta-analysis. Hemoglobin differences were significantly lower in TXA patients compared to non-TXA patients in both the rTHA (weighted mean difference [WMD] -0.79 g/dl, P = .016) and rTKA (WMD -0.64 g/dl, P = .048) groups. There was a significant reduction in red blood cell transfusion units in TXA patients compared to controls in both the rTHA (WMD 0.98, P = .006) and rTKA (WMD -0.49, P = .007) groups. Pooled analysis showed a significantly decreased blood transfusion rate in TXA patients in both rTHA (relative risk 0.56, P < .001) and rTKA (relative risk 0.40, P = .012) groups. Meta-analyses of venous thromboembolism complications showed no difference between the TXA and non-TXA groups (P > .05).

CONCLUSIONS

TXA was found to be effective and safe in both rTHA and rTKA, regardless of administration dose or route.