Association of Intravenous Tranexamic Acid and the Risk of Allogenic Blood Transfusion in Revision Hip Arthroplasty: a Meta-Analysis of 4517 Patients

Revision hip arthroplasty (RHA) is associated with high rates of bleeding. Tranexamic acid (TXA) has been widely used in primary hip arthroplasty (PHA) to minimize blood loss and transfusions. This study aimed to evaluate the efficacy and safety of intravenous (IV) TXA in RHA. PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify studies published up to June 2019. Potential studies evaluating the efficacy and safety of IV TXA during RHA were included. Risk ratio (RR) of allogenic blood transfusion (ABT) and venous thromboembolic (VTE) events in TXA and no-TXA groups were calculated. We summarized 7 cohort observational studies (COSs) including 4517 participants. Intravenous TXA had an association with a reduced risk of ABT [pooled RR = 0.578; 95% confidence interval (CI): 0.448 to 0.745] compared with no-TXA cohort in the perioperative period. No significant difference was seen in VTE events (pooled RR = 1.335; 95% CI: 0.586–3.040, P = 0.492) between TXA and no-TXA cohorts. Further subgroup analysis strengthened blood-sparing efficacy of TXA. IV TXA is associated with a lower risk of ABT following RHA, without increasing the risk of VTE. However, due to limited number of COSs, well-designed randomized controlled trials are required to draw concrete conclusions.