Tropical versus intravenous tranexamic acid treatment in primary unilateral total knee arthroplasty: a meta-analysis of randomized controlled trials
CHEN Meng-cun
WANG Jin-long
YANG Shu-hua
LIU Xianzhe
Abstract：Objective To perform a meta-analysis to compare the efficacy of intra-articular and intravenous utilization of tranexamic acid in primary unilateral total knee arthroplasty. Methods All randomized controlled trials in the PubMed, ScientceDirect, CENTRAL, Embase and CNKI databases were retrieved to assess the effectiveness and safety of intra-articular and intravenous tranexamic acid regimen. Main analytical points: blood loss (blood loss volume, drainage, maximal hemoglobin decrease), blood transfusion rate and thromboembolic complications (pulmonary embolism and deep venous thrombosis). Subgroup analyzes were performed as necessary. Results A total of 602 articles were found and 8 randomized controlled clinical trials involving 965 patients were finally included. Our meta-analysis found no statistically significant differences in blood transfusion rate (RR =1.00, 95％ CI =0.68 - 1.45, P =0.99) as well as within-group statistical heterogeneity (P =0.39, I2 =6％). There were no significant differences in maximal drop of Hb (MD =0.43, 95％ CI =-0.08 - 0.95, P =0.10) while significant differences existed between groups (P ＜ 0.001, I2 =93％). There were no significant differences in total blood loss (MD =-5.65, 95％ CI =-198.36 - 187.05, P =0.95) while significant differences existed between groups (P ＜ 0.001, I2 =98％). There were no significant differences in total drainage amount (MD =40.73, 95％ CI =-16.83 - 98.28, P =0.17) while significant differences existed between groups (P ＜ 0.001, I2 =81％). There were no significant differences in thromboembolic complication rate (RR =1.11, 95％ CI =0.47 - 2.65, P =0.81) as well as within-group statistical heterogeneity (P =0.68, I2 =0％) between intra-articular and intravenous usage of tranexamic acid. Conclusions Intra-articular and intravenous tranexamic acid regimen have similar efficacy and clinical value in the reduction of blood loss and blood transfusion rate without sacrificing the safety of the operation.
Keywords：Tranexamic acidAdministrationtopicalArthroplastyreplacementkneeMeta-analysis
Publication Date：2018-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 270-276 )