Outcome Comparison Between Tranexamic Acid And Torniquet In Patients Undergoing Total Knee Arthroplasty: A Systematic Review

Abstract

IntroductionTotal knee arthroplasty (TKA) is coupled with severe blood loss. Numerous methods have been used to lessen intraoperative and postoperative blood loss, including Tourniquets and tranexamic acid (TXA). This study intended to investigate comparation using tourniquet only and Tranexamic acid (TXA) only in Total Knee Arthroplasty.

Objectives: We aim to know the efficacy of using tranexamic acid instead of torniquet in patients undergoing total knee arthroplasty.

Methods: This study, conducted in 2024, adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were retrieved from databases including PubMed, ProQuest, and EBSCO with relevant studies focusing on TXA and torniquet use in patient underwent TKA. Study quality was assessed using the RoB 2 and JBI Critical Appraisal Tool, and meta-analysis was performed using a random-effects model in Review Manager version 5.4.

Results: The final analysis included five studies, revealing that TXA significantly reduced perioperative blood loss (MD = 573.34 mL, p = 0.01) compared to the tourniquet group, which had higher transfusion rates (OR = 7.52, p < 0.01) with no observed heterogeneity. While hemoglobin level changes favored TXA, hospital stay showed no significant difference between the two methods.

Conclusions: The use of tranexamic acid in TKA appears to offer advantages over tourniquet application in terms of reducing perioperative blood loss, lowering transfusion rates, and lowering length of stay patient. Although tourniquets remain useful in some cases, TXA’s efficacy and safety suggest it may be a preferable choice in TKA procedures for optimizing blood management and patient recovery. Further standardized research is needed to refine best practices in TKA blood management.