Is combined use of intravenous and intraarticular tranexamic acid superior to intravenous or intraarticular tranexamic acid alone in total knee arthroplasty? A meta-analysis of randomized controlled trials

Abstract

BackgroundTranexamic acid (TXA) has been proven to be effective in reducing blood loss and transfusion rate after total knee arthroplasty (TKA) without increasing the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Recently, an increasing number of studies have been interested in applying combined intravenous (IV) with intraarticular (IA) tranexamic acid in total knee arthroplasty. The purpose of this meta-analysis was to compare the blood loss and complications of combined TXA with IV TXA or IA TXA on TKA.MethodsSystematic search of literatures were conducted to identify related articles that were published in PubMed, MEDLINE, Embase, the Cochrane Library, SpringerLink, ClinicalTrials.gov, and Ovid from their inception to September 2016. All studies that compare blood loss and complications of combined TXA and IV TXA or IA TXA on TKA were included. Main outcomes were collected and analyzed by the Review Manager 5.3.ResultsFive studies were included in the present meta-analysis. There was significant difference in total blood loss and blood volume of drainage when compared combined TXA group with IV TXA group or IA TXA group (P < 0.05). There was no difference in transfusion rate and thromboembolic complications when comparing combined TXA with IV TXA or IA TXA alone (P > 0.05).ConclusionsCompared with administration of IA TXA or IV TXA alone on TKA, combined use of TXA has advantages in reducing total blood loss and blood volume of drainage without increasing the incidence of thromboembolic complications. We recommend combined TXA as the preferred option for patients undergoing TKA.

Effect of Multiple Doses of Intravenous Tranexamic Acid on Perioperative Blood Loss in Total Knee Arthroplasty: A Randomized Controlled Study

“…There are four methods for the administration of TXA to reduce blood loss in TKA: oral, intramuscular, intravenous, and intra‐articular. Intravenous combined with intra‐articular administration may be the optimal bleeding‐control strategy 25 . We limited the tourniquet inflation time to reduce intraoperative bleeding.…”

Multiple-dose tranexamic acid for perioperative blood loss in total knee arthroplasty in patients with rheumatoid arthritis：a single-blinded, randomised, parallel-controlled study protocol in China

“… 25 45 46 It has been reported that an intravenous infusion of TXA, combined with intra-articular injection may be the optimal bleeding-control scheme. 47 48 Previous studies have shown that knee joint swelling after TKA is associated with HBL in the joint cavity. TXA can reduce postoperative HBL, thereby relieving the swelling around the joint.…”

Minimizing Blood Loss and Transfusions in Total Knee Arthroplasty

“…19 Combined use of IV and IA proved to be superior to IV alone in the reduction in blood loss with no difference in safety. 34 Multiple doses with a combination of preoperative, intraoperative, and postoperative regiments were found to have increasing effectiveness in reducing TBL with no difference in safety profile, but are not practical and difficult to implement. 34,35 A combination of oral and IA TXA was compared with IA only and proved to be significantly better with regard to TR, TBL, and Hgb levels.…”

“…34 Multiple doses with a combination of preoperative, intraoperative, and postoperative regiments were found to have increasing effectiveness in reducing TBL with no difference in safety profile, but are not practical and difficult to implement. 34,35 A combination of oral and IA TXA was compared with IA only and proved to be significantly better with regard to TR, TBL, and Hgb levels. 27 It appears from the large number of studies that TXA is safe and effective in many different regimens of use.…”