Combined use of intravenous and topical versus intravenous tranexamic acid in primary total knee and hip arthroplasty: a meta-analysis of randomised controlled trials.
BACKGROUND
This meta-analysis aimed to evaluate the efficiency and safety of combined intravenous and topical methods of application versus single intravenous of tranexamic acid in primary total knee and hip arthroplasty.


METHODS
A systematic search was carried out in MEDLINE (from 1966 to 25 September 2016), PubMed (from 1966 to 25 September 2016), Embase (from 1980 to 25 September 2016), ScienceDirect (from 1985 to 25 September 2016) and the Cochrane Library. Only high-quality randomised controlled trials (RCT) were identified. Two authors independently performed data extraction and quality assessment of included studies. Meta-analysis was conducted using Review Manager 5.1 software.


RESULTS
Six RCTs that included 687 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences in terms of total blood loss (MD = -193.59, 95% CI -338.06 to -49.13, P = 0.009), transfusion rate (RD = -0.07, 95% CI -0.12 to -0.03, P = 0.001), haemoglobin decline (MD = -0.51, 95% CI -0.83 to -0.18, P = 0.01) and length of stay (MD = -0.20, 95% CI -0.38 to -0.02, P = 0.03) between groups.


CONCLUSIONS
Combined administration of tranexamic acid (TXA) in patients with total knee and hip arthroplasty was associated with significantly reduced total blood loss, transfusion requirements, postoperative haemoglobin decline and length of stay compared to single application alone but was not associated with prolonged operation time. Moreover, no adverse effects, such as superficial infection, deep vein thrombus (DVT) or pulmonary embolism (PE), were associated with TXA. We suggest that combined administration of TXA demonstrated excellent clinical efficacy and safety in patients with total knee and hip arthroplasty. More importantly, well-designed studies with larger sample size are needed to provide further reliable evidence for the combined use of TXA.
Ji Lin Agricultural University Hospital, Ji Lin, China.
Jun-Feng
JF
Li
Chest surgery, Cancer hospital of Ji Lin, Ji Lin, China.
Hang
H
Li
Chest surgery, Cancer hospital of Ji Lin, Ji Lin, China.
Hui
H
Zhao
Integrated TCM & Western Medicine Department, Cancer hospital of Ji Lin, Ji Lin, China.
Jun
J
Wang
Pharmacy Department, Cancer hospital of Ji Lin, Ji Lin, China.
Shen
S
Liu
Chest surgery, Cancer hospital of Ji Lin, Ji Lin, China.
Yang
Y
Song
Department of Radiotherapy, Cancer hospital of Ji Lin, Changchun, Ji Lin, China. 844092278@qq.com.
Hong-Fen
HF
Wu
D061605:Administration, Intravenous; D000287:Administration, Topical; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
Blood loss; Meta-analysis; Total hip replacement; Total knee and hip arthroplasty; Total knee replacement; Tranexamic acid