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Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials

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Abstract

Background

Tranexamic acid (TXA) is an antifibrinolytic drug used widely to prevent bleeding in total knee arthroplasty (TKA). However, there is no consensus regarding the administration routes of TXA. This meta-analysis aimed to investigate the efficacy of topical (intra-articular) versus intravenous TXA in reducing blood loss and transfusion rate in patients who underwent TKA.

Method

We conducted a Pubmed, EMBASE, Cochrane Library, and Web of Science search for randomized controlled trials (RCTs) comparing topical versus intravenous TXA in TKA. Two authors conducted selection of studies, data extraction, and assessment of risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software.

Result

Sixteen RCTs with a total of 1330 patients were included. Current meta-analysis indicated that there were no significant differences in total blood loss (MD = −41.64 ml; 95 % CI: −163.43 ml to 80.18 ml; P = 0.50), drain output (MD = 22.44, 95 % CI: −11.18 to 56.06, P = 0.19), transfusion rate (RR = 0.89, 95 % CI: 0.62 to 1.27, P = 0.52), the drop of Hb level at post-operative day 1 (MD = 0.26, 95 % CI −0.03 to 0.55, P = 0.03), day 2 (MD = −0.08, 95 % CI −0.76 to 0.59, P = 0.81), day 3 (MD = −0.20, 95 % CI −0.77 to 0.37, P = 0.49), and length of stay (MD = −0.10; 95 % CI: −0.17 to −0.02; P = 0.02) between the topical group and intravenous group. In addition, no significant differences were found regarding the incidence of adverse effects such as deep venous thrombosis (RR = 1.08, 95 % CI: 0.48 to 2.40, P = 0.86), pulmonary embolism (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), wound complications (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), and infection (RR = 0.74, 95 % CI: 0.30 to 1.85, P = 0.52) between the two groups.

Conclusion

Our meta-analysis of 16 RCTs revealed that both topical TXA and intravenous TXA are effective in reducing blood loss and transfusion rates in patients who underwent TKA.

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Authors and Affiliations

  1. Department of Comprehensive Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Zhonghuan South Road, Beijing, 100102, China

    Shangquan Wang, Xinxia Gao & Yan An

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  1. Shangquan Wang
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  2. Xinxia Gao
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  3. Yan An
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Correspondence to Yan An.

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Shangquan Wang and Xinxia Gao contributed equally to this work and should be listed as co-first authors

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Wang, S., Gao, X. & An, Y. Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. International Orthopaedics (SICOT) 41, 739–748 (2017). https://doi.org/10.1007/s00264-016-3296-y

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