Comparative efficacy and safety of different hemostatic methods in total hip arthroplasty: a network meta-analysis

• Main Authors: Zhihu Zhao, Jianxiong Ma, Xinlong Ma
• Format: Article
• Language: English
• Published: BMC 2019-01-01
• Series: Journal of Orthopaedic Surgery and Research
• Subjects: Tranexamic acid; Fibrin sealant; Total hip arthroplasty; Blood loss
• Online Access: http://link.springer.com/article/10.1186/s13018-018-1028-2

Abstract Background It is unclear which kind of interventional therapy is the best when reducing blood loss in patients prepared for total hip arthroplasty (THA). We performed this network meta-analysis to rank the best intervention arm for blood loss control in THA patients. Methods We searched electronic databases about randomized controlled trials (RCTs) to compare three treatments (topical tranexamic acid (TXA), intravenous TXA, and topical fibrin sealant (FS)) versus placebo for the people prepared for THA. Traditional and network meta-analyses were performed. The quality assessment was conducted using Cochrane Collaboration’s tool. The network meta-analysis was conducted using Stata 13.0 software. Results Finally, a total of 32 RCTs were included in this network meta-analysis. Topical TXA, intravenous TXA, and topical FS significantly decreased the need for transfusion and total blood loss when compared with placebo. And intravenous TXA ranks the first hemostasis agent for reducing the need for transfusion and total blood loss. There was no significant difference between these three treatments (intravenous TXA, topical TXA, and topical FS) in the occurrence of deep venous thrombosis (DVT). Conclusion Intravenous TXA may be the best way to reduce the need for transfusion and total blood loss. More direct studies that focused on topical TXA versus FS are needed in the future.