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Meta-Analysis
. 2019 Nov;98(46):e17796.
doi: 10.1097/MD.0000000000017796.

The efficiency and safety of oral tranexamic acid in total hip arthroplasty: A meta-analysis

Yipeng Xu  1 , Shaoting Sun  2 , Qing Feng  1 , Guanfeng Zhang  1 , Bin Dong  1 , Xiaoyan Wang  1 , Ming Guo  1
Affiliations
Meta-Analysis

The efficiency and safety of oral tranexamic acid in total hip arthroplasty: A meta-analysis

Yipeng Xu et al. Medicine (Baltimore). 2019 Nov.

Abstract

Background: Intravenous (IV), topical and combination of both application of tranexamic acid (TXA) can reduce blood loss, hemoglobin drop, and transfusion rate in patients following total hip arthroplasty (THA). Lately, published articles reported that oral TXA had as similar blood-saving as IV and topical TXA in THA. The purpose of this meta-analysis is to investigate the efficiency and safety of oral TXA in THA.

Methods: We systematically searched articles about oral administration of TXA in THA from PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Chinese Wanfang database.

Study eligibility criteria: The outcomes were collected and analyzed by the Review Manager 5.3.

Results: Nine RCTs and 1 CCT, containing 1305 patients, were ultimately included according to the inclusion criteria and exclusion criteria in the meta-analysis. The effectiveness of oral TXA was as similar as the IV or topical TXA in regard to hemoglobin drop (SMD = -0.14; 95% CI, [-0.28, 0.01]; P = .06), total blood loss (SMD = 0.01; 95% CI, [-0.13, 0.16]; P = .84), transfusion rate (OR = 0.76; 95% CI, [0.38, 1.55]; P = .37). Compared with single oral TXA or blank group, multiple oral TXA effectively reduced hemoglobin drop (SMD = -1.06; 95% CI, [-1.36, -0.77]; P < .05), total blood loss (SMD = -1.30; 95% CI, [-1.66, -0.94]; P < .05), transfusion rate (OR = 0.53; 95% CI, [0.29, 0.95]; P = .03). There were no significant difference in terms of length of stay and complication among all of enrolled studies.

Conclusion: Oral TXA has favorable effect of blood-saving and do not increase risk of complication in patients following THA. Oral TXA may have no effect in the length of stay. More high quality RCTs are necessary.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
The search results and selection procedure.
Figure 2
Figure 2
Forest plot showing hemoglobin drop comparing oral to IV or topical TXA.
Figure 3
Figure 3
Forest plot showing hemoglobin drop comparing multiple oral to single oral TXA or blank group.
Figure 4
Figure 4
Forest plot showing total blood loss comparing oral to IV or topical TXA.
Figure 5
Figure 5
Forest plot showing total blood loss comparing oral to IV or topical TXA.
Figure 6
Figure 6
Forest plot showing transfusion rate comparing oral to IV or topical TXA.
Figure 7
Figure 7
Forest plot showing transfusion rate comparing multiple oral TXA to single oral TXA or blank group.
Figure 8
Figure 8
Forest plot showing length of stay comparing oral to IV or topical TXA.
Figure 9
Figure 9
Forest plot showing length of stay comparing multiple oral to single oral TXA or blank group.
Figure 10
Figure 10
Forest plot showing complication oral to IV or topical TXA.
Figure 11
Figure 11
Forest plot showing complication multiple oral to single oral TXA or blank group.
See this image and copyright information in PMC

References

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