The Optimal Dose, Efficacy and Safety of Tranexamic Acid on Hemorrhage Control for High Tibial Osteotomy: A Network Meta-Analysis.

Objective: This systematic review and network meta-analysis was performed to explore the optimal dose, efficacy, and safety of tranexamic acid (TXA) treatments versus placebo for high tibial osteotomy (HTO) patients.

Methods: PubMed, Embase, Cochrane Library, Wanfang database, and Chinese National Knowledge Infrastructure (CNKI) databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to March 2024. Interventions included TXA and placebo treatments. The outcomes included total blood loss, drainage, hemoglobin drop, the occurrence of deep venous thrombosis (DVT) and hematoma. Traditional meta-analysis and network meta-analysis were performed by Stata and R software, respectively.

Results: Traditional meta-analysis revealed that TXA was associated with a decrease in the total blood loss, drainage volume, and hemoglobin drop (p < 0.05). There was no significant difference between TXA and placebo in terms of the occurrence of DVT and hematoma (p > 0.05). Compared with placebo, intravenous (iv) 10 mg/kg, iv 10 mg/kg (3 doses), iv 2 g, iv 2 g (2 doses), iv 2 g + topical (top) 3 g, iv 50 mg/kg, and top 10 mg/kg decreased the total blood loss with statistical significance (p < 0.05). Compared with placebo, iv 10 mg/kg (WMD = -379.91, 95% CI: -378.92, -81.22) decreased the drainage volume with statistical significance. Compared with placebo, iv 10 mg/kg (3 doses), iv 1 g, iv 1 g + top 2 g, iv 2 g + top 1 g, and iv 50 mg/kg decreased the hemoglobin drop with statistical significance. No statistically significant difference was found when the two interventions were compared against each other for the occurrence of DVT and hematoma (p > 0.05). The SUCRA shows that iv 10 mg/kg ranked first for reducing total blood loss (SUCRA, 90.7%) and drainage volume (SUCRA, 94.3%). The SUCRA shows that iv 1 g + top 2 g ranked first (SUCRA, 93.7%) for reducing hemoglobin drop.

Conclusion: Administration with TXA was associated with a decrease in blood loss in HTO patients. The optimal dose of TXA for reducing blood loss was iv 10 mg/kg. As for reducing hemoglobin drop, iv 1 g + top 2 g ranked first. Administration of TXA was not associated with an increase in the occurrence of DVT and hematoma. However, most evidence was graded as low/very low confidence due to study limitations, imprecision, and heterogeneity. Therefore, these findings should be interpreted as preliminary signals rather than definitive conclusions. Further high-quality randomized trials are required to validate dose-dependent efficacy and long-term safety outcomes.