Comparison of intravenous versus topical tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of tenrandomized trials.

Abstract

Aim: The optimal management approach for tranexamic acid(TXA)in primary total hip arthroplasty (THA) is still controversial. This meta-analysis aimed to evaluate the efficacy and safety of intravenous versus topical TXAduringTHA. Materials & methods: PubMed, Google Scholar, Embaseand the Cochrane library were searched for all randomized controlled trials comparing topical and intravenous TXA (iTXA)following primary THA. The primary outcome consisted of blood loss including total blood loss, intraoperative blood lossand hidden blood loss (HBL), hemoglobin (Hb) level of postoperative day 1, maximum Hb dropand transfusion incidence. The second outcome included drainage volume, complicationsand length of stay. Extracted data were statistically analyzed with the Stata11.0. Results: A total of ten randomized controlled trials containing 1295 patients were included in the study. A similar effect of transfusion rate, total blood loss, Hb level of postoperative day 1, drainage volume, deep vein thrombosis eventsand wound complications appeared in the two routes. Intraoperative blood loss (weighted mean difference [WMD]= -12.687, 95% CI: -22.291, -3.083; p=0.010), HBL (WMD =14.276, 95% CI: 9.936, 19.459; p<0.001) and maximum Hb drop (WMD =-0.400, 95% CI: -0.577, -0.222; p<0.001) were significantly reduced in the intravenous group compared with topical group. Conclusion: The present result indicated comparable safety and transfusion rate for intravenous and topical TXA in primary THA, while the intravenous approach demonstrated a smaller intraoperative blood loss, HBL and maximum Hb drop.