title: Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  This study aims to compare the effectiveness and safety of topical versus intravenous tranexamic acid (TXA) in reducing blood loss in primary total knee arthroplasty (TKA).
  
  
  METHODS
  PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedicine Literature (CBM), Wanfang Database and China National Knowledge Infrastructure (CNKI), and Google Scholar were searched for randomized controlled studies (RCTs) that compared topical versus intravenous TXA in terms of reducing blood loss during TKA from their inception to September 2015. This systematic review and meta-analysis was performed according to PRISMA criteria.
  
  
  RESULTS
  Twelve studies reporting 12 RCTs comprising 1130 patients were included. Compared with the intravenous administration of TXA, the topical administration of TXA showed no significant differences in total blood loss (MD 2.08, 95% CI -68.43 to 72.60, P = 0.95), blood loss in drainage (MD 18.49, 95% CI -40.01 to 76.98, P = 0.54), hidden blood loss (MD 4.75, 95% CI -337.94 to 347.44, P = 0.99), need for transfusion (RR = 0.92, 95% CI 0.67~1.25, P = 0.58), hemoglobin (Hb) decline (MD -0.42, 95% CI -0.89 to 0.05, P = 0.08), and DVT occurrence (RR = 1.17, 95% CI 0.55~2.50, P = 0.68).
  
  
  CONCLUSIONS
  Compared with intravenous administration TXA, topical administration TXA exhibits comparable effectiveness and safety in terms of reducing blood loss during TKA. Due to the poor quality of the included studies, more high-quality RCTs are needed to identify the optimal method and dose of TXA after TKA.
authors.affiliation: Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.
authors.forename: Tao-Ping
authors.initials: TP
authors.lastname: Chen
authors.affiliation: Hebei University, Yuhua Dong Road, 342, Yuhua District, Baoding, Hebei Province, 071000, China. shandongjb@qq.com.
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Chen
authors.affiliation: Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.
authors.forename: Jian-Bao
authors.initials: JB
authors.lastname: Jiao
authors.affiliation: Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.
authors.forename: Yun-Fei
authors.initials: YF
authors.lastname: Wang
authors.affiliation: Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.
authors.forename: Li-Gang
authors.initials: LG
authors.lastname: Qian
authors.affiliation: Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Guo
authors.affiliation: Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.
authors.forename: Cui-Yu
authors.initials: CY
authors.lastname: Han
authors.affiliation: Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.
authors.forename: Tong-Huan
authors.initials: TH
authors.lastname: Shi
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004334:Drug Administration Schedule; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Meta-analysis; Total knee arthroplasty; Tranexamic acid