title: Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials.
abstract: Tranexamic acid (TXA) is an antifibrinolytic drug used widely to prevent bleeding in total knee arthroplasty (TKA). However, there is no consensus regarding the administration routes of TXA. This meta-analysis aimed to investigate the efficacy of topical (intra-articular) versus intravenous TXA in reducing blood loss and transfusion rate in patients who underwent TKA.
  
  
  
  We conducted a Pubmed, EMBASE, Cochrane Library, and Web of Science search for randomized controlled trials (RCTs) comparing topical versus intravenous TXA in TKA. Two authors conducted selection of studies, data extraction, and assessment of risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software.
  
  
  
  Sixteen RCTs with a total of 1330 patients were included. Current meta-analysis indicated that there were no significant differences in total blood loss (MD = -41.64 ml; 95 % CI: -163.43 ml to 80.18 ml; P = 0.50), drain output (MD = 22.44, 95 % CI: -11.18 to 56.06, P = 0.19), transfusion rate (RR = 0.89, 95 % CI: 0.62 to 1.27, P = 0.52), the drop of Hb level at post-operative day 1 (MD = 0.26, 95 % CI -0.03 to 0.55, P = 0.03), day 2 (MD = -0.08, 95 % CI -0.76 to 0.59, P = 0.81), day 3 (MD = -0.20, 95 % CI -0.77 to 0.37, P = 0.49), and length of stay (MD = -0.10; 95 % CI: -0.17 to -0.02; P = 0.02) between the topical group and intravenous group. In addition, no significant differences were found regarding the incidence of adverse effects such as deep venous thrombosis (RR = 1.08, 95 % CI: 0.48 to 2.40, P = 0.86), pulmonary embolism (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), wound complications (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), and infection (RR = 0.74, 95 % CI: 0.30 to 1.85, P = 0.52) between the two groups.
  
  
  
  Our meta-analysis of 16 RCTs revealed that both topical TXA and intravenous TXA are effective in reducing blood loss and transfusion rates in patients who underwent TKA.
authors.affiliation: Department of Comprehensive Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Zhonghuan South Road, Beijing, 100102, China.
authors.forename: Shangquan
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Comprehensive Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Zhonghuan South Road, Beijing, 100102, China.
authors.forename: Xinxia
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of Comprehensive Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Zhonghuan South Road, Beijing, 100102, China. anyanbj@163.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: An
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Intravenous; Topical; Total knee arthroplasty; Tranexamic acid