782 Tranexamic Acid Administration for Blood Loss in High-Tibial Osteotomy (HTO): A Systematic Review and Meta-Analysis
H Dadah, C O'Donnell- Surgery
Abstract
Aim
To evaluate clinical outcomes after tranexamic acid (TXA) administration with the aim of reducing blood loss during and after high-tibial osteotomy (HTO) with available clinical evidence.
Method
Systematic search methodology of PUBMED, EMBASE and CINAHL databases was conducted in July 2022. The search workflow was undertaken in adherence to PRISMA guidelines. Inclusion criteria: 1) randomised control trials, cohort or case-control studies. 2) Studies reporting outcomes after TXA administration, of any route, before or after HTO, compared to: placebo, control, different doses or routes. 3) Studies reporting blood loss, including haemoglobin drop, estimated blood loss, transfusion requirement and complications. Excluded: case reports, reviews, abstracts, non-HTO studies, non-human studies and duplicates.
Results
Eleven studies were identified comparing 974 patients. Nine studies had placebo comparison and two used single dose TXA vs multiple doses. All studies reported on post-operative haemoglobin, nine on blood loss. In the 6 TXA vs placebo studies reporting on total blood loss, the TXA group had a pooled, estimated standardised mean difference (SMD) in blood loss of -2.37 [95% CI -3.67, -1.07, P = 0.0004]. For haemoglobin drop, on post-operative days 1, 2, and 5 SMDs were: POD1: -0.97 [95% CI -1.19, -0.75 P<0.00001], POD2: -0.74 [95% CI -1.03, -0.46, P<0.00001], POD5: -0.87 [-1.10, -0.64, P<0.00001].
Conclusions
The data demonstrates that TXA administration in HTO significantly reduces blood loss and haemoglobin decrease; results of particular relevance given supply shortages of NHS blood resources. Furthermore, this can greatly improve recovery, complications, and post-operative stay.