Abstract
BACKGROUND: Persistent bleeding and inflammation during and after surgery are frequent problems in hip and knee surgeries that lead to high blood transfusion needs and slow recovery. Tranexamic acid (TXA) is a popular agent used to control bleeding, but its efficacy may be improved when combined with Carbazochrome sodium sulfate (CSS), capillary hemostatic agent that stabilizes microvascular integrity and reduces capillary bleeding. This meta-analysis compares the efficacy and safety of CSS plus TXA and TXA alone in controlling bleeding during surgery, inflammation, and postoperative outcomes. METHODS: A thorough literature search was performed across multiple databases until January 2025 to identify pertinent randomized controlled trials comparing the efficacy and safety of the combination of Carbazochrome sodium sulfate and Tranexamic acid against Tranexamic acid alone for the reduction of blood loss. The study's primary outcomes were total blood loss, hidden blood loss, intraoperative blood loss, and maintenance of hemoglobin levels. The quality of the studies included was evaluated utilizing the RoB 2 tool. Subsequent to data extraction, a meta-analysis was conducted utilizing RevMan 5 software with a random effects model. RESULTS: This systematic review identified six studies (n = 800 patients) fulfilling research criteria. The meta-analysis has shown that there was a robust reduction in total blood loss (MD = -230.92 mL, 95% CI [-271.69 to -190.14], P < 0.00001) and hidden blood loss (MD = -220.52 mL, 95% CI [-263.78 to -177.27], P < 0.00001) when comparing the intervention group with TXA alone with topical administration providing less blood loss than Intravenous. In addition to the above measure, hemoglobin preservation was also improved (MD = -0.59 g/dL, 95% CI [-0.73 to -0.46], P < 0.00001). Furthermore, compared to TXA alone, the combination group had much lower requirements for blood transfusion (RR = 0.13, 95% CI [0.04 to 0.38], P = 0.0003) while there was no increase in complication with wounds or venous thromboembolism. CONCLUSION: The use of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) proves to be more effective at controlling bleeding, hemoglobin loss, postoperative inflammation, and pain after hip and knee arthroplasty than using TXA alone. There was also increased efficacy from topical application, as well as increased safety and decreased transfusion use. Combination therapy had good results; however, its relative inefficacy on operative duration and duration of hospital admissions indicates that more work needs to be done on this issue.