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Tranexamic acid administration for the prevention of periprosthetic joint infection and surgical site infection: a systematic review and meta-analysis
Introduction Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA...
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| Published in: | Archives of orthopaedic and trauma surgery 2023-11, Vol.143 (11), p.6883-6899 |
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| container_title | Archives of orthopaedic and trauma surgery |
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| creator | Imanishi, Keiji Kobayashi, Naomi Kamono, Emi Yukizawa, Yohei Takagawa, Shu Choe, Hyonmin Kumagai, Ken Inaba, Yutaka |
| description | Introduction
Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI).
Materials and methods
Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case–control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I).
Results
Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49–0.62) (
P
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| doi_str_mv | 10.1007/s00402-023-04914-x |
| format | article |
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Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI).
Materials and methods
Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case–control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I).
Results
Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49–0.62) (
P
< 0.00001), and that of PJI alone (OR 0.53; 95% CI 0.47–0.59) (
P
< 0.00001). TXA reduced the incidence of overall infection in patients who underwent total hip arthroplasty (THA; OR 0.51; 95% CI: 0.35–0.75) (P = 0.0005) and total knee arthroplasty (TKA; OR 0.55; 95% CI: 0.43–0.71) (
P
< 0.00001). Intravenous administration of TXA reduced the incidence of overall infection (OR 0.59; 95% CI 0.47–0.75) (
P
< 0.0001), whereas topical administration did not.
Conclusions
Intravenous administration of TXA reduces the incidence of overall infection in patients undergoing both THA and TKA.
Level of evidence
Level III.</description><identifier>ISSN: 1434-3916</identifier><identifier>ISSN: 0936-8051</identifier><identifier>EISSN: 1434-3916</identifier><identifier>DOI: 10.1007/s00402-023-04914-x</identifier><identifier>PMID: 37355487</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Administration, Topical ; Antifibrinolytic agents ; Antifibrinolytic Agents - therapeutic use ; Arthritis, Infectious ; Arthroplasty, Replacement, Hip - adverse effects ; Blood Loss, Surgical - prevention & control ; Hip Arthroplasty ; Humans ; Joint surgery ; Medicine ; Medicine & Public Health ; Meta-analysis ; Orthopedics ; Prosthesis-Related Infections - drug therapy ; Prosthesis-Related Infections - etiology ; Prosthesis-Related Infections - prevention & control ; Randomized Controlled Trials as Topic ; Surgical site infections ; Surgical Wound Infection - prevention & control ; Systematic review ; Tranexamic Acid - therapeutic use</subject><ispartof>Archives of orthopaedic and trauma surgery, 2023-11, Vol.143 (11), p.6883-6899</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-215e759e80695887a255745179ebf691394c3ad45faad57fa9602e430ca740533</citedby><cites>FETCH-LOGICAL-c375t-215e759e80695887a255745179ebf691394c3ad45faad57fa9602e430ca740533</cites><orcidid>0000-0002-2419-0860</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37355487$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Imanishi, Keiji</creatorcontrib><creatorcontrib>Kobayashi, Naomi</creatorcontrib><creatorcontrib>Kamono, Emi</creatorcontrib><creatorcontrib>Yukizawa, Yohei</creatorcontrib><creatorcontrib>Takagawa, Shu</creatorcontrib><creatorcontrib>Choe, Hyonmin</creatorcontrib><creatorcontrib>Kumagai, Ken</creatorcontrib><creatorcontrib>Inaba, Yutaka</creatorcontrib><title>Tranexamic acid administration for the prevention of periprosthetic joint infection and surgical site infection: a systematic review and meta-analysis</title><title>Archives of orthopaedic and trauma surgery</title><addtitle>Arch Orthop Trauma Surg</addtitle><addtitle>Arch Orthop Trauma Surg</addtitle><description>Introduction
Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI).
Materials and methods
Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case–control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I).
Results
Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49–0.62) (
P
< 0.00001), and that of PJI alone (OR 0.53; 95% CI 0.47–0.59) (
P
< 0.00001). TXA reduced the incidence of overall infection in patients who underwent total hip arthroplasty (THA; OR 0.51; 95% CI: 0.35–0.75) (P = 0.0005) and total knee arthroplasty (TKA; OR 0.55; 95% CI: 0.43–0.71) (
P
< 0.00001). Intravenous administration of TXA reduced the incidence of overall infection (OR 0.59; 95% CI 0.47–0.75) (
P
< 0.0001), whereas topical administration did not.
Conclusions
Intravenous administration of TXA reduces the incidence of overall infection in patients undergoing both THA and TKA.
Level of evidence
Level III.</description><subject>Administration, Topical</subject><subject>Antifibrinolytic agents</subject><subject>Antifibrinolytic Agents - therapeutic use</subject><subject>Arthritis, Infectious</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Blood Loss, Surgical - prevention & control</subject><subject>Hip Arthroplasty</subject><subject>Humans</subject><subject>Joint surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Orthopedics</subject><subject>Prosthesis-Related Infections - drug therapy</subject><subject>Prosthesis-Related Infections - etiology</subject><subject>Prosthesis-Related Infections - prevention & control</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Surgical site infections</subject><subject>Surgical Wound Infection - prevention & control</subject><subject>Systematic review</subject><subject>Tranexamic Acid - therapeutic use</subject><issn>1434-3916</issn><issn>0936-8051</issn><issn>1434-3916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1DAUhS0Eoj_wAiyQJTZsAtd_45gdqoAiVWJT1tZtclM8SpzBdujMi_C8eGYKRSxY2fL5zrF9D2MvBLwRAPZtBtAgG5CqAe2EbraP2KnQSjfKidXjv_Yn7CznNYCQrYOn7ERZZYxu7Sn7eZ0w0han0HHsQs-xn0IMuSQsYY58mBMv34hvEv2geDiaB76hFDZpzlUp1bieQyw8xIG6A4Gx53lJt6HDkedQ6EF7x5HnXS404d5ZUwPdHQwTFWww4rjLIT9jTwYcMz2_X8_Z148fri8um6svnz5fvL9qOmVNaaQwZI2jFlbOtK1FaYzVRlhHN8PKCeV0p7DXZkDsjR3QrUCSVtCh1WCUOmevj7n1N98XysVPIXc0jnUo85K9bKXTSkptK_rqH3Q9L6m-d09ZEK0SDiolj1RXx5MTDX6TwoRp5wX4fWv-2JqvrflDa35bTS_vo5ebifo_lt81VUAdgVyleEvp4e7_xP4CesWlRg</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Imanishi, Keiji</creator><creator>Kobayashi, Naomi</creator><creator>Kamono, Emi</creator><creator>Yukizawa, Yohei</creator><creator>Takagawa, Shu</creator><creator>Choe, Hyonmin</creator><creator>Kumagai, Ken</creator><creator>Inaba, Yutaka</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2419-0860</orcidid></search><sort><creationdate>20231101</creationdate><title>Tranexamic acid administration for the prevention of periprosthetic joint infection and surgical site infection: a systematic review and meta-analysis</title><author>Imanishi, Keiji ; 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Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI).
Materials and methods
Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case–control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I).
Results
Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49–0.62) (
P
< 0.00001), and that of PJI alone (OR 0.53; 95% CI 0.47–0.59) (
P
< 0.00001). TXA reduced the incidence of overall infection in patients who underwent total hip arthroplasty (THA; OR 0.51; 95% CI: 0.35–0.75) (P = 0.0005) and total knee arthroplasty (TKA; OR 0.55; 95% CI: 0.43–0.71) (
P
< 0.00001). Intravenous administration of TXA reduced the incidence of overall infection (OR 0.59; 95% CI 0.47–0.75) (
P
< 0.0001), whereas topical administration did not.
Conclusions
Intravenous administration of TXA reduces the incidence of overall infection in patients undergoing both THA and TKA.
Level of evidence
Level III.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37355487</pmid><doi>10.1007/s00402-023-04914-x</doi><tpages>17</tpages><orcidid>https://orcid.org/0000-0002-2419-0860</orcidid></addata></record> |
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| subjects | Administration, Topical Antifibrinolytic agents Antifibrinolytic Agents - therapeutic use Arthritis, Infectious Arthroplasty, Replacement, Hip - adverse effects Blood Loss, Surgical - prevention & control Hip Arthroplasty Humans Joint surgery Medicine Medicine & Public Health Meta-analysis Orthopedics Prosthesis-Related Infections - drug therapy Prosthesis-Related Infections - etiology Prosthesis-Related Infections - prevention & control Randomized Controlled Trials as Topic Surgical site infections Surgical Wound Infection - prevention & control Systematic review Tranexamic Acid - therapeutic use |
| title | Tranexamic acid administration for the prevention of periprosthetic joint infection and surgical site infection: a systematic review and meta-analysis |
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