Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis.

Abstract

This meta-analysis was designed to compare the effectiveness and safety of intravenous (IV) versus topical administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty (TKA) by evaluating the need for allogenic blood transfusion, incidence of postoperative complications, volume of postoperative blood loss, and change in haemoglobin levels. Studies were included in this meta-analysis to check whether they assessed the allogenic blood transfusion rate, postoperative complications including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT), volume of postoperative blood loss via drainage, estimated blood loss, total blood loss, and change in haemoglobin levels before and after surgery in primary TKA with TXA administered through both the IV and topical routes. Ten studies were included in this meta-analysis. The proportion of patients requiring allogenic blood transfusion (OR 1.34, 95% CI 0.63-2.81; n.s.) and the proportion of patients who developed postoperative complications including PTE or DVT (OR 0.85, 95% CI 0.41 to 1.77; n.s.) did not significantly differ between the two groups. There was 52.3mL less blood loss via drainage (95% CI -50.74 to 185.66mL; n.s.), 52.1mL greater estimated blood loss (95% CI -155.27 to 51.03mL; n.s.), and 51.4mL greater total blood loss (95% CI -208.16 to 105.31mL; n.s.) in the topical TXA group as compared to the IV TXA group. The two groups were also similar in terms of the change in haemoglobin levels (0.02g/dL, 95% CI -0.36 to 0.39g/dL; n.s.). In primary TKA, there are no significant differences in the transfusion requirement, postoperative complications, blood loss, and change in haemoglobin levels between the IV and topical administration of TXA. In addition, results from subgroup analysis evaluating the effect of the times of TXA administration through the IV route suggested that double IV dose of TXA is more effective than single dose in terms of the transfusion requirements and blood loss via drainage. The current meta-analysis indicates that IV administration of 10mg/kg of TXA 20min before inflation of the tourniquet followed by 10mg/kg of TXA 15min before deflation of the tourniquet is effective and safe. The topical administration of 2g of TXA mixed with 100mL of normal saline after wound closure could be an alternative option in patients at greater risk of thromboembolic complications. Meta-analysis, Level III.