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International Orthopaedics

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01-04-2017 | Original Paper

Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials

Authors: Shangquan Wang, Xinxia Gao, Yan An

Published in: International Orthopaedics | Issue 4/2017

Abstract

Background

Tranexamic acid (TXA) is an antifibrinolytic drug used widely to prevent bleeding in total knee arthroplasty (TKA). However, there is no consensus regarding the administration routes of TXA. This meta-analysis aimed to investigate the efficacy of topical (intra-articular) versus intravenous TXA in reducing blood loss and transfusion rate in patients who underwent TKA.

Method

We conducted a Pubmed, EMBASE, Cochrane Library, and Web of Science search for randomized controlled trials (RCTs) comparing topical versus intravenous TXA in TKA. Two authors conducted selection of studies, data extraction, and assessment of risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software.

Result

Sixteen RCTs with a total of 1330 patients were included. Current meta-analysis indicated that there were no significant differences in total blood loss (MD = −41.64 ml; 95 % CI: −163.43 ml to 80.18 ml; P = 0.50), drain output (MD = 22.44, 95 % CI: −11.18 to 56.06, P = 0.19), transfusion rate (RR = 0.89, 95 % CI: 0.62 to 1.27, P = 0.52), the drop of Hb level at post-operative day 1 (MD = 0.26, 95 % CI −0.03 to 0.55, P = 0.03), day 2 (MD = −0.08, 95 % CI −0.76 to 0.59, P = 0.81), day 3 (MD = −0.20, 95 % CI −0.77 to 0.37, P = 0.49), and length of stay (MD = −0.10; 95 % CI: −0.17 to −0.02; P = 0.02) between the topical group and intravenous group. In addition, no significant differences were found regarding the incidence of adverse effects such as deep venous thrombosis (RR = 1.08, 95 % CI: 0.48 to 2.40, P = 0.86), pulmonary embolism (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), wound complications (RR = 0.56, 95 % CI: 0.05 to 5.99, P = 0.63), and infection (RR = 0.74, 95 % CI: 0.30 to 1.85, P = 0.52) between the two groups.

Conclusion

Our meta-analysis of 16 RCTs revealed that both topical TXA and intravenous TXA are effective in reducing blood loss and transfusion rates in patients who underwent TKA.

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Title: Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials
Authors: Shangquan Wang
Xinxia Gao
Yan An
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3296-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials

Abstract

Background

Method

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Result

Conclusion

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