Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Abstract

Background: This study aims to compare the effectiveness and safety of topical versus intravenous tranexamic acid (TXA) in reducing blood loss in primary total knee arthroplasty (TKA).

Methods: PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedicine Literature (CBM), Wanfang Database and China National Knowledge Infrastructure (CNKI), and Google Scholar were searched for randomized controlled studies (RCTs) that compared topical versus intravenous TXA in terms of reducing blood loss during TKA from their inception to September 2015. This systematic review and meta-analysis was performed according to PRISMA criteria.

Results: Twelve studies reporting 12 RCTs comprising 1130 patients were included. Compared with the intravenous administration of TXA, the topical administration of TXA showed no significant differences in total blood loss (MD 2.08, 95% CI -68.43 to 72.60, P = 0.95), blood loss in drainage (MD 18.49, 95% CI -40.01 to 76.98, P = 0.54), hidden blood loss (MD 4.75, 95% CI -337.94 to 347.44, P = 0.99), need for transfusion (RR = 0.92, 95% CI 0.67~1.25, P = 0.58), hemoglobin (Hb) decline (MD -0.42, 95% CI -0.89 to 0.05, P = 0.08), and DVT occurrence (RR = 1.17, 95% CI 0.55~2.50, P = 0.68).

Conclusions: Compared with intravenous administration TXA, topical administration TXA exhibits comparable effectiveness and safety in terms of reducing blood loss during TKA. Due to the poor quality of the included studies, more high-quality RCTs are needed to identify the optimal method and dose of TXA after TKA.

Keywords: Meta-analysis; Total knee arthroplasty; Tranexamic acid.

Fig. 1

Flow diagram for the included studies

Fig. 2

Summary of the risk of bias in each study

Fig. 3

Graph of the risk of bias for the included studies

Fig. 4

Forest plots comparing topical versus intravenous TXA administration regarding the need for transfusion. A Mantel-Haenszel fixed-effects model was used. Mean differences are shown with 95% CI

Fig. 5

Forest plots comparing topical versus intravenous TXA for the need for total blood loss, blood loss in drainage, and hidden blood loss. An inverse-variance random-effects model was used. Mean differences are shown with 95% CI

Fig. 6

Forest plots comparing topical and intravenous TXA administration in terms of Hb decline. An inverse-variance random-effects model was used. Mean differences are shown with 95% CI

Fig. 7

Forest plots comparing topical and intravenous TXA administration in terms of the occurrence of DVT. A Mantel-Haenszel fixed-effects model was used. Relative risk values are shown with 95% CI

Fig. 8

Sensitivity analysis of each end-point for total blood loss (a), blood loss in drainage (b) and hidden blood loss (c) after TKA