A comparison of combined intravenous and topical administration of tranexamic acid with intravenous tranexamic acid alone for blood loss reduction after total hip arthroplasty: A meta-analysis.
BACKGROUND
The optimal dose and protocol of tranexamic acid (TXA) for reducing blood loss in total hip arthroplasty (THA) is controversial. Intravenous TXA (IV-TXA) and combined IV-TXA with topical TXA are the two common protocol after THA. A meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of combined IV and topical TXA with IV-TXA alone in reducing blood loss after THA.


METHODS
PubMed, Medline, Embase, Web of Science, the Cochrane Library, China Wanfang database and Google database were searched from the inception to February 2017 to identify RCTs that comparing combined IV and topical TXA with IV-TXA alone for patients prepared for primary THA. Total blood loss, hidden blood loss, transfusion rate, hemoglobin drop, length of hospital stay and the occurrence of deep venous thrombosis (DVT) were pooled to comprehensive analyses the efficacy and safety of combined IV and topical TXA with IV-TXA alone. Software Stata 12.0 was used to calculated relevant data.


RESULTS
Six RCTs involving 747 patients were finally included in the meta-analysis. Combined TXA decrease the volume of total blood loss and hidden blood loss by 250.37 ml (MD = -250.37; 95% CI: -376.43 to -124.31, P = 0.000) and 117.23 ml respectively (MD = -117.23; 95% CI: 228.38 to -6.07, P = 0.091). Meanwhile, combined TXA can also decrease the transfusion rate by 9.1% (RR = 0.32; 95% CI: 0.17 to 0.63; P = 0.001). No significant differences were seen in hemoglobin drop, the length of hospital stay and the occurrence of DVT between the two groups (P > 0.05).


CONCLUSIONS
Our meta-analysis suggests that the combined application of IV and topical TXA for patients undergoing THA may reduce the total blood loss compared with IV use alone without increasing the risk of postoperative complications. However, due to the quality and number of included studies, more studies were need to further identify the optimal dose for combine IV-TXA.
Department of Orthopaedics, the Eighty-Ninth Hospital of PLA, No. 256, North Palace West Street, Weifang City, Shandong province, 261021, China. Electronic address: liuxiangcheng@163.com.
Xiangcheng
X
Liu
Department of Orthopaedics, the Eighty-Ninth Hospital of PLA, No. 256, North Palace West Street, Weifang City, Shandong province, 261021, China.
Jinglong
J
Liu
Department of Orthopaedics, the Eighty-Ninth Hospital of PLA, No. 256, North Palace West Street, Weifang City, Shandong province, 261021, China.
Ganghe
G
Sun
D000279:Administration, Cutaneous; D061605:Administration, Intravenous; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002681:China; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D014148:Tranexamic Acid / Q000008:administration & dosage*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
Combined; Intravenous; Meta-analysis; Total hip arthroplasty; Tranexamic acid