Effect of fibrin sealant on blood loss following total knee arthroplasty: a systematic review and meta-analysis
- PMID: 24316285
- DOI: 10.1016/j.ijsu.2013.11.011
Effect of fibrin sealant on blood loss following total knee arthroplasty: a systematic review and meta-analysis
Abstract
Objective: A systematic review of randomized controlled trials was conducted to examine the efficacy of fibrin sealants for the reduction of postoperative blood loss and allogeneic red blood cell transfusion in total knee arthroplasty (TKA).
Methods: Studies published through May 2013 were identified from PubMed, Embase, the Cochrane library, ScienceDirect, and other databases. Two independent reviewers assessed the quality of methodology using the Grade of Recommendations Assessment, Development and Evaluation approach and extracted data from literature. The mean difference (MD) of blood loss, hemoglobin loss, and risk ratios (RR) of transfusion rate and adverse events in the fibrin-treated and placebo groups were pooled throughout the study. The relevant data were analyzed using Stata 11.0 software.
Results: Eight studies were included in the review, with a total sample size of 558 patients. The drainage blood loss [MD = -354.02 mL, 95% confidence interval (CI) (-500.87 to -207.18); P < 0.05], reduction in calculated total blood loss [MD = -402.12, 95% CI (-599.16 to -205.08); P < 0.05], hemoglobin loss [MD = -0.86 g/dL, 95% CI (-1.10 g/dL to -0.61 g/dL); P < 0.05], and transfusion rate [RR = 0.62, 95% CI (0.45-0.86); P < 0.05] were all significantly reduced following treatment with fibrin sealants. There were no significant differences in the incidence of adverse events [RR = 0.69, 95% CI (0.32-1.59); P > 0.05] among the study groups.
Conclusions: The results of the present meta-analysis suggest that fibrin sealants for patients undergoing TKA may reduce blood loss and maintain higher hemoglobin levels, particularly when fibrin sealants are used at higher dosage. Furthermore, fibrin sealants do not increase the risk of postoperative deep vein thrombosis, superficial infection, pulmonary embolism, and hematoma. Further evaluation is required to confirm our findings before fibrin sealants can be used in patients undergoing TKA.
Level of evidence: II.
Keywords: Blood loss; Fibrin sealant; Meta-analysis; Surgical; Total knee arthroplasty.
Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Similar articles
-
Fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery.Cochrane Database Syst Rev. 2018 Jun 23;6(6):CD009621. doi: 10.1002/14651858.CD009621.pub3. Cochrane Database Syst Rev. 2018. Update in: Cochrane Database Syst Rev. 2020 Mar 11;3:CD009621. doi: 10.1002/14651858.CD009621.pub4. PMID: 29934987 Free PMC article. Updated. Review.
-
Topical use of topical fibrin sealant can reduce the need for transfusion, total blood loss and the volume of drainage in total knee and hip arthroplasty: A systematic review and meta-analysis of 1489 patients.Int J Surg. 2016 Dec;36(Pt A):127-137. doi: 10.1016/j.ijsu.2016.10.022. Epub 2016 Oct 20. Int J Surg. 2016. PMID: 27773860 Review.
-
Topical fibrin sealant versus intravenous tranexamic acid for reducing blood loss following total knee arthroplasty: A systematic review and meta-analysis.Int J Surg. 2016 Aug;32:31-7. doi: 10.1016/j.ijsu.2016.06.009. Epub 2016 Jun 16. Int J Surg. 2016. PMID: 27317900 Review.
-
Fibrin sealant before wound closure in total knee arthroplasty reduced blood loss: a meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2015 Jul;23(7):2019-25. doi: 10.1007/s00167-014-2898-4. Epub 2014 Feb 12. Knee Surg Sports Traumatol Arthrosc. 2015. PMID: 24525554
-
The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty. A prospective, randomized, multicenter study.J Bone Joint Surg Am. 1999 Nov;81(11):1580-8. doi: 10.2106/00004623-199911000-00010. J Bone Joint Surg Am. 1999. PMID: 10565650 Clinical Trial.
Cited by
-
Efficacy and safety of fibrin sealant application in patients undergoing thyroidectomy: a systematic review and meta-analysis.BMC Surg. 2024 Apr 24;24(1):122. doi: 10.1186/s12893-024-02414-2. BMC Surg. 2024. PMID: 38658932 Free PMC article.
-
Topical Fibrin Sealant (Tisseel@) Does Not Provide a Synergic Blood-Conservation Effect with Tranexamic Acid in Total Knee Arthroplasty-A Prospective Randomized Controlled Trial.Medicina (Kaunas). 2023 Nov 26;59(12):2078. doi: 10.3390/medicina59122078. Medicina (Kaunas). 2023. PMID: 38138181 Free PMC article. Clinical Trial.
-
Prevention of postoperative anemia in hip hemiarthroplasty for femoral neck fractures: comparison between local haemostatic agents.Orthop Rev (Pavia). 2022 Oct 13;14(6):38574. doi: 10.52965/001c.38574. eCollection 2022. Orthop Rev (Pavia). 2022. PMID: 36267213 Free PMC article.
-
Reducing perioperative blood loss with antifibrinolytics and antifibrinolytic-like agents for patients undergoing total hip and total knee arthroplasty.J Orthop. 2019 Jul 2;16(6):513-516. doi: 10.1016/j.jor.2019.06.025. eCollection 2019 Nov-Dec. J Orthop. 2019. PMID: 31680743 Free PMC article. Review.
-
The effect of a fibrin sealant on knee function after total knee replacement surgery. Results from the FIRST trial. A multicenter randomized controlled trial.PLoS One. 2018 Jul 25;13(7):e0200804. doi: 10.1371/journal.pone.0200804. eCollection 2018. PLoS One. 2018. PMID: 30044846 Free PMC article. Clinical Trial.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials