Topical and intravenous tranexamic acid (TXA) were found to significantly reduce blood loss compared with placebo in patients who have undergone bone surgery, suggesting that both administration methods may be effective at promoting wound healing.
Topical and intravenous tranexamic acid (TXA) proved to be equally effective in reducing blood loss in bone surgery, suggesting that it may also help promote wound healing, according to a systematic review and meta-analysis published in the World Journal of Clinical Cases.
“Given the consideration of smaller dose and less medical cost, topical TXA is recommended for bone surgery. However, more studies are needed to further verify our findings in the future,” wrote the investigators.
TXA is an antifibrinolytic drug that has been used for over half a century. The drug binds to plasminogen and prevents the conversion of plasminogen to plasmin, which causes fibrinolysis, an enzymatic process of breaking down fibrin in blood clots.
Use of TXA to reduce blood loss and blood transfusion in major orthopedic surgery is widely regarded as being safe but previous studies have not confirmed whether TXA administration after surgery is associated with an increased risk of thromboembolism, which is caused by a blood vessel being blocked by a blood clot that dislodged from another site in the circulation.
Topical TXA is a popular formulation for providers to use. However, surgeons do not have a comprehensive guideline on what doses and administration methods for the drug are safe, especially because topical TXA is often prescribed off-label. Additionally, evidence supporting the efficacy of topical vs intravenous TXA regarding blood loss reduction and wound healing promotion in bone surgery still needs a systemic review.
The investigators searched 5 electronic resources for literature published between 2010 and 2020 for articles published in English involving a randomized controlled trial, controlled clinical trial, or a prospective or retrospective cohort study looking at adult participants. In addition, the effects of topical and/or intravenously administrated TXA after bone surgery had to be documented.
A total of 1360 abstracts and titles were found during the literature search, 18 of which were included in the final analysis. The sample size of the included studies totaled 1994 patients who had bone surgery.
Breaking the studies down by surgery type, 9 involved total knee arthroplasty, 2 concerned trochanteric fracture surgery, 1 addressed intertrochanteric fractures, 2 involved total shoulder arthroplasty, 2 looked at total hip replacement, and 1 addressed orthognathic surgery.
The impact of topical vs intravenous TXA was examined in 5 studies, showing that there was no significant difference between the 2 administration methods on reducing blood transfusion (odds ratio [OR], 0.20; 95% CI, –0.50 to 0.89; P = .58). The heterogeneity between studies was mild (I2 < 0%).
A similar effect was observed when comparing blood loss reduction for both versions of TXA, demonstrating that there was no significant different between topical and intravenous TXA, as observed in 6 studies. The mean difference between the 2 was 74.06 mL (95% CI, –8.17 to 156.39; P = .08), and a high heterogeneity was detected (I2 = 88.98%).
The effects of TXA compared with a placebo was compared in 10 studies, demonstrating that the drug performed significantly better at reducing blood transfusion than placebo. The OR was –1.56 (95% CI, –1.96 to –1.17; P = .00). Moderate heterogeneity was found (I2 = 35.63%) among the studies.
Likewise, TXA was found to significantly reduce blood loss compared with placebo, as examined in 12 studies. The results demonstrated that TXA reduced blood loss by an average 277.51 mL (95% CI, –410.47 to –144.5; P = 0.00) compared with placebo, and the studies showed high heterogeneity (I2 = 97.94%).
The lack of evaluation for optimal dose and timing of topical TXA and the significant heterogeneity detected in the blood loss findings were listed as limitations of the review. The investigators said that both areas require more research.
“It is clinically significant to use TXA to reduce blood loss and transfusion in bone surgery, which might be beneficial for wound healing,” wrote the investigators.
Xu J-W, Qiang H, Li T-L, Wang Y, Wei X-X, Li F. Efficacy of topical vs intravenous TXA in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis. World J Clin Cases. June 16, 2021;9(17):4210-4220. doi: 10.12998/wjcc.v9.i17.4210