Cochrane · systematic review · CD013295
Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta‐analysis
Gibbs, VN, Champaneria, R, Sandercock, J, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
InjuriesAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
47
current version
GRADE rated
45
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 2 · 4.3%Very low 7 · 14.9%Low 30 · 63.8%Moderate 8 · 17%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings: Risk of a blood transfusion up to 30 days post‐surgery
Population: individuals undergoing planned hip or knee replacement surgery Interventions: antifibrinolytics (tranexamic acid, aprotinin or epsilon‐aminocaproic acid), fibrin sealants Comparator (reference): placebo Outcome: risk of requiring a blood transfusion within 30 days of surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 47 Total participants: 4398 | no estimate extracted | 47 participants | Ungraded |
TXA given orally and intra‐articularly at a total dose of greater than 3 g pre‐incision, intraoperatively and postoperatively | no estimate extracted | 3 participants | Moderate |
TXA given orally at a total dose of 3 g pre‐incision and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intravenously and orally at a total dose of greater than 3 g intraoperatively and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intravenously at a total dose of 2 g pre‐incision | no estimate extracted | 2 participants | Moderate |
TXA given intravenously and intra‐articularly at a total dose of 2 g intraoperatively | no estimate extracted | 2 participants | Moderate |
TXA given intravenously and orally at a total dose of greater than 3 g pre‐incision and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intravenously at a total dose of 1 g pre‐incision and postoperatively | no estimate extracted | 1 participants | Low |
TXA given intravenously and intra‐articularly at a total dose of greater than 3 g pre‐incision, intraoperatively and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intra‐articularly at a total dose of 2 g intraoperatively | no estimate extracted | 2 participants | Low |
TXA given intravenously at a total dose of 1 g intraoperatively and postoperatively | no estimate extracted | 1 participants | Low |
TXA given orally at a total dose of greater than 3 g pre‐incision and postoperatively | no estimate extracted | 3 participants | Very low |
TXA given orally at a total dose of 2 g pre‐incision | no estimate extracted | 2 participants | Low |
TXA given intra‐articularly at a total dose of 1 g intraoperatively | no estimate extracted | 1 participants | Low |
TXA given intravenously at a total dose of greater than 3 g intraoperatively and postoperatively | no estimate extracted | 3 participants | Moderate |
TXA given intravenously and intra‐articularly at a total dose of 2 g pre‐incision and intraoperatively | no estimate extracted | 2 participants | Very low |
TXA given orally at a total dose of 2 g pre‐incision and postoperatively | no estimate extracted | 2 participants | Low |
TXA given intravenously at a total dose of 2 g pre‐incision and intraoperatively | no estimate extracted | 2 participants | Very low |
TXA given intravenously at a total dose of 1 g pre‐incision and intraoperatively | no estimate extracted | 1 participants | Moderate |
Aprotinin given intravenously | no estimate extracted | NR | Low |
Desmopressin given intravenously | no estimate extracted | NR | Low |
EACA given intravenously | no estimate extracted | NR | Very low |
Fibrin (topical) | no estimate extracted | NR | Very low |
TXA given intravenously at a total dose of 1 g intraoperatively | no estimate extracted | 1 participants | Low |
TXA given intravenously at a total dose of 1 g pre‐incision | no estimate extracted | 1 participants | Moderate |
TXA given intravenously at a total dose of 1 g pre‐incision, intraoperatively and postoperatively | no estimate extracted | 1 participants | Low |
TXA given intravenously at a total dose of 2 g intraoperatively and postoperatively | no estimate extracted | 2 participants | Low |
TXA given intravenously at a total dose of 2 g pre‐incision and postoperatively | no estimate extracted | 2 participants | Moderate |
TXA given intravenously at a total dose of 3 g intraoperatively and postoperatively | no estimate extracted | 3 participants | Moderate |
Summary of findings: Risk of deep vein thrombosis (DVT) up to 90 days post‐surgery
Population: individuals undergoing planned hip or knee replacement surgery Interventions: antifibrinolytics (tranexamic acid, aprotinin) Comparator (reference): placebo Outcome: risk of deep vein thrombosis within 90 days of surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 19 Total participants: 2395 | no estimate extracted | 19 participants | Ungraded |
TXA given intravenously and orally at a total dose of greater than 3 g intraoperatively and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intravenously and intra‐articularly at a total dose of 2 g pre‐incision and intraoperatively | no estimate extracted | 2 participants | Low |
TXA given intravenously and intra‐articularly at a total dose of greater than 3 g pre‐incision, intraoperatively and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intravenously at a total dose of greater than 3 g intraoperatively and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intravenously and orally at a total dose of greater than 3 g pre‐incision and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intravenously at a total dose of 3 g intraoperatively and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intra‐articularly at a total dose of 2 g intraoperatively | no estimate extracted | 2 participants | Low |
TXA given orally and intra‐articularly at a total dose of greater than 3 g pre‐incision, intraoperatively and postoperatively | no estimate extracted | 3 participants | Low |
TXA given intravenously at a total dose of 2 g pre‐incision and postoperatively | no estimate extracted | 2 participants | Low |
TXA given intravenously at a total dose of 1 g postoperatively | no estimate extracted | 1 participants | Low |
TXA given intravenously at a total dose of 2 g postoperatively | no estimate extracted | 2 participants | Low |
TXA given intravenously at a total dose of 2 g intraoperatively and postoperatively | no estimate extracted | 2 participants | Very low |
Aprotinin given intravenously | no estimate extracted | NR | Very low |
TXA given intra‐articularly at a total dose of 1 g intraoperatively | no estimate extracted | 1 participants | Low |
TXA given intravenously at a total dose of 1 g pre‐incision | no estimate extracted | 1 participants | Low |
TXA given intravenously at a total dose of 1 g pre‐incision and intraoperatively | no estimate extracted | 1 participants | Low |
TXA given intravenously at a total dose of 1 g intraoperatively | no estimate extracted | 1 participants | Low |