Intravenous versus topical tranexamic acid in primary total hip replacement: A systemic review and meta-analysis.
OBJECTIVE
Total hip arthroplasty (THA) is associated with substantial blood loss. Tranexamic acid (TXA) could reduce perioperative blood loss. The optimal administration routine of TXA remains controversial. The objective of the present systemic review and meta-analysis was to compare the effectiveness and safety of various application methods of tranexamic acid in primary THA.


METHODS
Potential relevant literature was identified from electronic databases including Medline, PubMed, Embase, ScienceDirect, web of science and Cochrane Library. Grey academic studies were also identified from the references of the included literature. There was no language restriction. The pooling of data was carried out by using RevMan 5.1.


RESULTS
Three randomized controlled trials (RCTs) and two non-RCTs involving 1614 patients met the inclusion criteria. Current meta-analysis indicated that there were no significant differences in terms of total blood loss (MD = -30.04, 95% CI: -114.67 to 54.59, P = 0.49), postoperative hemoglobin level (MD = -0.29, 95% CI: -0.68 to 0.10, P = 0.14), transfusion rate (RD = -0.02, 95% CI: -0.5 to -0.00, P = 0.09), length of stay ((MD = -0.14, 95% CI: -0.30 to 0.01, P = 0.07) or operation time ((MD = 1.00, 95% CI: -0.31 to 2.31, P = 0.14) between treatment groups. No significant differences were found regarding the incidence of adverse effects such as wound infection (RD = -0.01, 95% CI: -0.06 to 0.04, P = 0.66), myocardial infarction (MI) (RD = -0.01, 95% CI: -0.04 to 0.02, P = 0.61), deep venous thrombosis (DVT) (RD = 0.00, 95% CI: -0.01 to 0.01, P = 0.51) or pulmonary embolism (PE) (RD = RD = 0.00, 95% CI: -0.01 to 0.01, P = 0.63) between groups.


CONCLUSIONS
The topical administration of TXA in THA carried similar hemostasis effects compared with intravenous use without an increased risk of thrombotic complications. No other adverse effect was identified. Topical TXA application was a simple, safe, effective and cost-effective adjunct for blood management following primary THA. For patients with a high risk of thromboembolic events, there may be benefits with topical administration.
Traumatology Department, Tianjin Hospital, Tianjin, 300211, PR China.
Xiang
X
Sun
Traumatology Department, Tianjin Hospital, Tianjin, 300211, PR China. Electronic address: 3244213427@qq.com.
Qiang
Q
Dong
Traumatology Department, Tianjin Hospital, Tianjin, 300211, PR China.
Yin-Guang
YG
Zhang
D061605:Administration, Intravenous; D000287:Administration, Topical; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000008:administration & dosage*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
Blood loss; Meta-analysis; Total hip arthroplasty; Tranexamic acid