The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

• Published in: BMC musculoskeletal disorders 2018-09, Vol.19 (1), p.321-321, Article 321
• Main Authors: Xiong, Huazhang, Liu, Yi, Zeng, Yi, Wu, Yuangang, Shen, Bin
• Format: Article
• Language: English
• Subjects: Acids; Administration, Intravenous; Administration, Topical; Aged; Anemia; Antifibrinolytic agents; Antifibrinolytic Agents - administration & dosage; Antifibrinolytic Agents - adverse effects; Arthroplasty (knee); Arthroplasty, Replacement, Knee - adverse effects; Bias; Biomarkers - blood; Blood; Blood loss; Blood Loss, Surgical - prevention & control; Blood Transfusion; Clinical trials; Complications and side effects; Data processing; Dosage and administration; Drainage; Drug therapy; Embolism; Embolisms; Female; Hemoglobin; Hemoglobins - metabolism; Hemorrhage; Humans; Intravenous; Intravenous administration; Joint surgery; Knee; Knee replacement arthroplasty; Male; Meta-analysis; Methods; Middle Aged; Musculoskeletal diseases; Patient outcomes; Postoperative complications; Prevention; Pulmonary Embolism - blood; Pulmonary Embolism - etiology; Randomized Controlled Trials as Topic; Risk Factors; Studies; Surgery; Systematic review; Thrombosis; Topical; Total knee arthroplasty; Tourniquets; Tranexamic acid; Tranexamic Acid - administration & dosage; Tranexamic Acid - adverse effects; Treatment Outcome; Venous Thrombosis - blood; Venous Thrombosis - etiology
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-018-2181-9

The combined administration of intravenous (IV) and topical tranexamic acid (TXA) in primary total knee (TKA) knee remains controversial. The purpose of this meta-analysis was to assess the efficacy and safety of combined administration of IV and topical TXA in primary TKA. PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Google Search Engine and China National Knowledge Infrastructure databases were searched for randomized controlled trials (RCTs) were comparing the combined administration of IV and topical TXA following primary TKA. The primary outcomes were total blood loss, maximum hemoglobin drop, and deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The second outcomes were drainage volume and transfusion requirements. Data were analyzed using RevMan 5.3. A total of 6 RCTs involving 701 patients were included in the meta-analysis. The combined group provided lower total blood loss (MD - 156.34 mL, 95% CI, - 241.51 to - 71.18; P = 0.0003), drainage volume (MD - 43.54 mL, 95% CI, - 67.59 to - 19.48; P = 0.0004), maximum hemoglobin drop (MD - 0.56 g/dl, 95% CI, - 0.93 to - 0.19; P = 0.003) than IV TXA alone. No significant difference were found in terms of transfusion requirements (RR 0.48, 95% CI, 0.16 to 1.44; P = 0.19), DVT (RR 1.01, 95% CI, 0.14 to 7.12; P = 0.99) and PE (RR 0.33, 95% CI, 0.01 to 7.91; P = 0.49) between the two group. Subgroup analyses shows that the combined group was less total blood loss in non-tourniquet (P = 0.0008), topical TXA dose > 1.5 g (P  1.5 g and number of IV TXA ≥ 2 doses of TXA. There was no increase the rates of DVT and PE.