Topical Use of Fibrin Sealant Can Reduce Blood Loss and Need for Transfusion in Total Knee and Hip Arthroplasty

To assess the safety and effectiveness of topical administration of fibrin sealants on postoperative blood loss and blood requirements in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), Chinese investigators searched electronic medical databases through February 2016 to identify randomized clinical trials (RCTs) for inclusion in a meta-analysis. Evaluated outcomes included transfusion requirements, total blood loss, length of hospital stay and occurrence of infection. A total of 19 RCTs enrolling 1,489 patients (405 hip and 1,084 knee replacements) were included.

Results of the meta-analysis indicated that topical administration of a fibrin sealant can decrease the need for transfusion (relative risk [RR], 0.33; 95% confidence interval [CI], 0.28 to 0.40; P < 0.001), decrease total blood loss (mean difference [MD], -138.25 mL, CI, -203.49 to -75.00 mL), decrease blood drainage loss (MD, -321.44 mL; CI, -351.96 to -290.92 mL; P <0.001) and shorten the length of hospital stay (MD, -0.98 days; CI,-1.35 to -0.62 days; P < 0.001). There was no evidence of an increased risk of infection with use of fibrin sealants (RR, 0.87; CI, 0.33 to 2.27; P = 0.775). The investigators concluded that topical use of fibrin sealant can effectively reduce the need for transfusions, total blood loss and volume of postsurgical drainage without increasing the risk of infection.