title: Combined use of intravenous and topical versus intravenous tranexamic acid in primary total joint arthroplasty: A meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To compare the safety and efficacy of combined use of intravenous and topical tranexamic acid with that of intravenous tranexamic acid in primary total joint arthroplasty.
  
  
  METHODS
  Literature was searched in PubMed, Cochrane Library, Embase, Medline, and China National Knowledge Infrastructure databases. Only randomized controlled trials were included in our study. Data were using fixed-effects or random-effects models with standard mean differences and risk ratios for continuous and dichotomous variables, respectively.
  
  
  RESULTS
  Seven randomized controlled trials encompassing 683 patients were retrieved for this meta-analysis. Outcomes showed that when compared with intravenous tranexamic acid, combined use of intravenous and topical tranexamic acid could significantly reduce total blood loss by a mean of 138.70 mL [95% confidence interval (CI): -196.14 to -81.26, p < 0.001], transfusion rates (risk ratio 0.42, 95% CI: 0.2 to 0.85, p < 0.001). No significant difference in the occurrence of deep vein thrombosis, pulmonary embolism was found between the two groups.
  
  
  CONCLUSIONS
  This meta-analysis indicated that comparing with only intravenous tranexamic acid, combined use of intravenous and topical tranexamic acid can significantly reduce blood loss and transfusion rate in primary total joint arthroplasty without increasing the risk of thrombotic complications. Therefore, we suggest that tranexamic acid should be intravenously combined with topically administered in primary total joint arthroplasty.
authors.affiliation: School of Basic Medicine and Clinical Pharmacy Affiliated to China Pharmaceutical University, Tongjiaxiang 24, Nanjing, 210009, China. Electronic address: 1481550246@qq.com.
authors.forename: Xue-Qin
authors.initials: XQ
authors.lastname: Zhang
authors.affiliation: The Fourth Clinical School Affiliated to Nanjing Medical University, Baiziting 42, Nanjing, 210008, China. Electronic address: 995736248@qq.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Ni
authors.affiliation: Department of Pharmacy, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China. Electronic address: 6221230@sina.com.
authors.forename: Wei-Hong
authors.initials: WH
authors.lastname: Ge
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006801:Humans; D011655:Pulmonary Embolism / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D020246:Venous Thrombosis / Q000139:chemically induced
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Combined use; Meta-analysis; Total joint arthroplasty; Tranexamic acid