Abstract
BackgroundTotal knee arthroplasty (TKA) is gradually regarded as an effective choice for end-stage osteoarthritis or rheumatic arthritis. In the past, the management of tranexamic acid (TXA) using intravenous injection or topical application has been extensively researched. However, several studies have reported that oral TXA has an effect on blood loss. Therefore, a meta-analysis should be performed to determine whether oral TXA helps to prevent blood loss.MethodsRandomized controlled trials or retrospective cohort studies about relevant studies were searched in PubMed (1996–April 2017), Embase (1980–April 2017), and the Cochrane Library (CENTRAL, April 2017). Six studies that compared oral TXA to non-TXA were included in our meta-analysis. Meta-analyses (PRISMA) guidelines, the Cochrane Handbook, and the Jadad scale were used to evaluate the included studies and the results to ensure that the meta-analysis was viable.ResultsIn accordance with inclusion and exclusion, six studies with 2553 patients (oral TXA = 1386, without TXA = 1167) were eligible and accepted into this meta-analysis. Pooled data indicated that the oral TXA group was effective compared to the without TXA group in terms of hemoglobin (Hb) drop (P < 0.05), blood loss at 24 h (P < 0.05), total blood loss (P < 0.05), and the transfusion rate (P < 0.05). No significant differences were found in the length of hospital stay (P = 0.96) and complications (P = 0.39).ConclusionCompared to the non-TXA group, the oral TXA group showed effects of blood sparing. Considering the cost and effectiveness, oral TXA is useful for TKA.
Highlights
Total knee arthroplasty (TKA) is gradually regarded as an effective choice for end-stage osteoarthritis or rheumatic arthritis
Inclusion criteria Studies were eligible for the meta-analysis if they met the following PICOS criteria: (1) participants: patients who received TKA for the first time; (2) intervention: oral administration of tranexamic acid (TXA); (3) comparison: nonTXA applied to TKA; (4) outcomes: hemoglobin drop, blood loss, transfusion rate, complications, and length of hospital stay; (5) study design: randomized controlled trials or retrospective cohort studies
The Jadad scale was used to evaluate the risk of bias for randomized controlled trials (RCTs), which consisted of random sequence generation, allocation concealment, the blinding of participants and personnel, incomplete outcome data, selective reporting, and other biases [17, 18]
Summary
Total knee arthroplasty (TKA) is gradually regarded as an effective choice for end-stage osteoarthritis or rheumatic arthritis. The management of tranexamic acid (TXA) using intravenous injection or topical application has been extensively researched. A meta-analysis should be performed to determine whether oral TXA helps to prevent blood loss. Total knee arthroplasty (TKA) is recommended as an effective method for end-stage knee osteoarthritis or rheumatoid arthritis [1]. It may cause severe blood loss during the perioperative period.
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