title: Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The purpose of this meta-analysis was to compare the blood loss and complications of intra-articular (IA) with intravenous (IV) tranexamic acid (TXA) for total knee arthroplasty (TKA).
  
  
  METHODS
  A comprehensive search of studies was conducted to identify related articles in Pubmed, Embase, Cochrane central Register of Controlled Trials, springerLink, OVID and the Research published from January 1980 to September 2016. All studies that compared IA TXA with IV TXA application on TKA were included. Main outcomes of the two methods were collected and analyzed by using Review Manager 5.3.
  
  
  RESULTS
  There were 16 randomized controlled trials with 1308 cases met the criteria. Compared with IV TXA, IA TXA had similar blood volume of drainage, hidden blood loss, transfusion rate and complications (P > 0.05). IA TXA had lower total blood loss than IV TXA, and there was significant difference (P < 0.05). Subgroup analysis of total blood loss based on times of IV TXA administration showed that repeat dose of IV TXA had a higher total blood loss and postoperative hemoglobin drop (P < 0.05) than IA TXA. However, single dose of IV TXA had a similar efficacy on total blood loss and postoperative hemoglobin drop (P > 0.05) when compared with IA TXA.
  
  
  CONCLUSIONS
  Both IA TXA and single dose of IV TXA are effective in reducing total blood loss and postoperative hemoglobin drop without increasing complications of DVT or PE. The current meta-analysis suggests that 1.5 g TXA by IA administration or 1 g TXA by IV administration 10 min before tourniquet deflation is effective and safe in patients undergoing TKA.
authors.affiliation: Department of Orthopedics, Union Hospital, Huazhong University of Science and Technology, 1277, Jie fang Avenue, Wuhan, China.
authors.forename: Bobin
authors.initials: B
authors.lastname: Mi
authors.affiliation: Department of Orthopedics, Union Hospital, Huazhong University of Science and Technology, 1277, Jie fang Avenue, Wuhan, China. liuguohui@medmail.com.cn.
authors.forename: Guohui
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Union Hospital, Huazhong University of Science and Technology, 1277, Jie fang Avenue, Wuhan, China.
authors.forename: Wu
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Deparetment of Rheumatology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.
authors.forename: Huijuan
authors.initials: H
authors.lastname: Lv
authors.affiliation: Department of Orthopedics, Union Hospital, Huazhong University of Science and Technology, 1277, Jie fang Avenue, Wuhan, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Union Hospital, Huazhong University of Science and Technology, 1277, Jie fang Avenue, Wuhan, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Zha
authors.affiliation: Department of Orthopedics, Union Hospital, Huazhong University of Science and Technology, 1277, Jie fang Avenue, Wuhan, China.
authors.forename: Qipeng
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, Union Hospital, Huazhong University of Science and Technology, 1277, Jie fang Avenue, Wuhan, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
mesh_terms: D061605:Administration, Intravenous; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans; D007270:Injections, Intra-Articular; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Intra-articular; Intravenous; Meta-analysis; Total knee arthroplasty; Tranexamic acid