Comment on the intravenous tranexamic acid use in revision total joint arthroplasty

Abstract

Dear editor Kuo et al thoroughly evaluated the safety and efficacy of intravenous tranexamic acid in revision total joint arthroplasty (TJA) via aspects of blood loss and transfusion, events of venous thromboembolism.1 We consider application of this drug of great value in revision TJA. However, we would like to address several concerns related to this meta-analysis. First, the conclusion of no increased risk of venous thromboembolism was drawn through assessment of five studies, according to the description in the context, yet data of only two studies were extracted in Figure 6, in the form of a forest plot. We carefully read the other five studies selected in this meta-analysis, and found three more of them that contained data of thromboembolic events.2–4 Two of them showed favorable results for no related event occurrence,2,3 and the third found increased incidence of thrombotic complications without statistical significance (P=0.3).4 We suggest these results should be included in the analysis, so as to raise the reliability of this conclusion. Second, there were some deficiencies in the literature search. Only three electronic databases (PubMed, Scopus, and Cochrane Central Register of Controlled Trials) were systematically searched. The small number of studies included might be a limitation of this meta-analysis. Since most of the investigators came from China, a more comprehensive search should also include Chinese databases, such as CBM on Disc and CNKI. We appreciate the investigators’ contribution in supplying us with an excellent safety and efficacy evaluation of intravenous tranexamic acid in revision TJA. If possible, we hope the investigators can make proper revisions to this meta-analysis to make it more credible. Moreover, for the disadvantages of unavoidable risk of bias caused by the limited number of qualified clinical trials or retrospective studies, further prospective randomized controlled trials are required, just as the investigators pointed out in the conclusion.