Push A Little Harder With the TXA

A massive network meta-analysis uncovered a surprising finding about a treatment we all thought we'd heard the last word on

What’s the Claim?

A new network meta-analysis from the Cochrane Library, based on 102 randomized trials (!), found that among patients undergoing unilateral or bilateral THA, TKA, UKA, or unilateral revision arthroplasty:

  • High-dose (>3 g) tranexamic acid (TXA) given orally and intra-articularly, before, during, and after arthroplasty, was the most-effective approach to prevent blood transfusions.
    • With this approach, the authors estimated that patients would get only three transfusions per 1000 procedures compared to 150 if no intervention were offered.
    • This approach had a 53% chance of being ranked first in the network meta-analysis of the many, many treatments they compared, based on moderate-certainty evidence.
    • The authors concluded that the mixed route of administration (oral and intra‐articular, oral and intravenous, or intravenous and intra‐articular) “may have been advantageous.”
  • Several other TXA-based approaches looked nearly as effective in terms of preventing anticipated transfusions, as long as the total dose was in the 2- to 3-g range, and there were no clear benefits to one route (oral, IV, intra-articular) over another.
  • Lower-dose TXA may not be as effective, and aprotinin, topical fibrin, and epsilon‐aminocaproic acid were not as effective.
  • High-dose TXA was not associated with increased risk of DVT; the authors didn’t have enough studies reporting on MI, PE, or death to do a proper analysis of those endpoints.

How’s It Stack Up?