title: Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis.
abstract: OBJECTIVE
  This meta-analysis was designed to compare the effectiveness and safety of intravenous (IV) versus topical administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty (TKA) by evaluating the need for allogenic blood transfusion, incidence of postoperative complications, volume of postoperative blood loss, and change in haemoglobin levels.
  
  
  METHODS
  Studies were included in this meta-analysis to check whether they assessed the allogenic blood transfusion rate, postoperative complications including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT), volume of postoperative blood loss via drainage, estimated blood loss, total blood loss, and change in haemoglobin levels before and after surgery in primary TKA with TXA administered through both the IV and topical routes.
  
  
  RESULTS
  Ten studies were included in this meta-analysis. The proportion of patients requiring allogenic blood transfusion (OR 1.34, 95 % CI 0.63-2.81; n.s.) and the proportion of patients who developed postoperative complications including PTE or DVT (OR 0.85, 95 % CI 0.41 to 1.77; n.s.) did not significantly differ between the two groups. There was 52.3 mL less blood loss via drainage (95 % CI -50.74 to 185.66 mL; n.s.), 52.1 mL greater estimated blood loss (95 % CI -155.27 to 51.03 mL; n.s.), and 51.4 mL greater total blood loss (95 % CI -208.16 to 105.31 mL; n.s.) in the topical TXA group as compared to the IV TXA group. The two groups were also similar in terms of the change in haemoglobin levels (0.02 g/dL, 95 % CI -0.36 to 0.39 g/dL; n.s.).
  
  
  CONCLUSIONS
  In primary TKA, there are no significant differences in the transfusion requirement, postoperative complications, blood loss, and change in haemoglobin levels between the IV and topical administration of TXA. In addition, results from subgroup analysis evaluating the effect of the times of TXA administration through the IV route suggested that double IV dose of TXA is more effective than single dose in terms of the transfusion requirements and blood loss via drainage. The current meta-analysis indicates that IV administration of 10 mg/kg of TXA 20 min before inflation of the tourniquet followed by 10 mg/kg of TXA 15 min before deflation of the tourniquet is effective and safe. The topical administration of 2 g of TXA mixed with 100 mL of normal saline after wound closure could be an alternative option in patients at greater risk of thromboembolic complications.
  
  
  METHODS
  Meta-analysis, Level III.
authors.affiliation: Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea.
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Shin
authors.affiliation: Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea.
authors.forename: Jung-Ro
authors.initials: JR
authors.lastname: Yoon
authors.affiliation: Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea.
authors.forename: Hoon-Nyun
authors.initials: HN
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Se-Hwan
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea. eoak22@empal.com.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Lee
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004322:Drainage; D006801:Humans; D007262:Infusions, Intravenous; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011655:Pulmonary Embolism / Q000209:etiology; D014111:Tourniquets; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D020246:Venous Thrombosis / Q000209:etiology
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Intravenous; Meta-analysis; Topical; Total knee arthroplasty; Tranexamic acid