title: Combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty: A meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The tranexamic acid (TXA) can reduce surgical perioperative blood loss. However, the optimal regimen of tranexamic acid remains controversial. The purpose of this meta-analysis was to compare the efficacy and safety of combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty.
  
  
  METHODS
  PubMed, EMbase, Cochrane library and OVID were searched. Eligible randomized controlled trials (RCTs) evaluating combined intravenous and topical TXA versus intravenous alone in primary total knee and hip arthroplasty were included. The relative risk (RR) or the mean difference (MD) for dichotomous or continuous data was calculated respectively, and heterogeneity was analyzed by chi-square and I2tests.
  
  
  RESULTS
  A total of five RCTs met the inclusion criteria were included. The meta-analysis indicated that there was statistically significant difference favoring the combined group in total blood loss(MD = -160.90, 95% CI[-201.26, -120.54]), P < 0.00001), hemoglobin drop (MD = -0.41, 95% CI[-0.73,0.08], P = 0.01), transfusion requirements(RR = 0.29, 95% CI[0.12,0.70], P = 0.006) and length of hospital stays (MD = -0.21, 95%CI[-0.40, -0.02], P = 0.03). Both groups showed similar outcomes regarding thromboembolic complications(RR = 0.84, 95% CI[0.26,2.70], P = 0.76).
  
  
  CONCLUSIONS
  Based on our study, Combined use of intravenous and topical TXA is more effective than intravenous TXA alone in primary total knee or hip arthroplasty without increasing the risk of thromboembolic complications. Further high quality studies with more patients are needed in future studies.
authors.affiliation: Department of Orthopedic Surgery, XuZhou Medical University Affiliated Hospital, XuZhou Medical University, XuZhou, JiangSu Province, 221000, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Shang
authors.affiliation: Department of Orthopedic Surgery, XuZhou Medical University Affiliated Hospital, XuZhou Medical University, XuZhou, JiangSu Province, 221000, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Orthopedic Surgery, XuZhou Medical University Affiliated Hospital, XuZhou Medical University, XuZhou, JiangSu Province, 221000, China.
authors.forename: Bai
authors.initials: B
authors.lastname: Zheng
authors.affiliation: Department of Orthopedic Surgery, XuZhou Medical University Affiliated Hospital, XuZhou Medical University, XuZhou, JiangSu Province, 221000, China.
authors.forename: Min
authors.initials: M
authors.lastname: Rui
authors.affiliation: Department of Orthopedic Surgery, XuZhou Medical University Affiliated Hospital, XuZhou Medical University, XuZhou, JiangSu Province, 221000, China. Electronic address: yehua-wang@sohu.com.
authors.forename: Yehua
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000287:Administration, Topical; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans; D007275:Injections, Intravenous; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000008:administration & dosage*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Combined use; Meta-analysis; Total hip arthroplasty; Total knee arthroplasty; Tranexamic acid