Oral vs intravenous tranexamic acid in total-knee arthroplasty and total hip arthroplasty

Abstract

Background: This study aimed to compare the efficacy and safety of oral tranexamic acid (TXA) with intravenous (IV) TXA in reducing perioperative blood loss in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). Methods: PubMed, Web of Science, Embase, and Cochrane Library were fully searched for relevant studies. Studies comparing the efficacy and safety of oral TXA with IV TXA in TKA and THA were included in this research. Odds ratio (OR) or risk difference (RD) was applied to compare dichotomous variables, while mean difference (MD) was used to compare continues variables. Results: A total of 7 studies (5 randomized controlled trials and 2 retrospective studies) were included into this study. As for patients undergoing TKA or THA, there were no obvious differences between oral TXA group and IV TXA group in hemoglobin (Hb) drop (MD = 0.06, 95% confidence interval [CI] = −0.01 to 0.13, P = .09), transfusion rate (OR = 0.78, 95% CI = 0.54–1.13, P = .19), total blood loss (MD = 16.31, 95% CI = −69.85 to 102.46, P = .71), total Hb loss (MD = 5.18, 95% CI = −12.65 to 23.02, P = .57), length of hospital stay (MD = -0.06, 95% CI = −0.30 to 0.18, P = .63), drain out (MD = 21.04, 95% CI = −15.81 to 57.88, P = .26), incidence of deep vein deep vein thrombosis (RD = 0.00, 95% CI = −0.01 to 0.01, P = .82) or pulmonary embolism (RD = 0.00, 95% CI = −0.01 to 0.01, P = .91). The sample size of this study was small and several included studies were with relatively low quality. Conclusion: Oral TXA is equivalent to IV TXA in reducing perioperative blood loss and should be recommended in TKA and THA. More high-quality studies are needed to elucidate this issue.

Intravenous administration of tranexamic acid to reduce blood loss during perioperative period in acetabular fracture surgery

“…At present, a large number of studies report that TXA is safe and effective in hip and knee joint replacement, regardless of the mode of administration, intravenous, topical, or combination [12][13][14][15]. However, no study has reported on the intravenous infusion of TXA in the acetabulum in terms of its effect on blood loss during the perioperative period in these fractures.…”

“…The effectiveness of intravenous use of TXA TXA is a synthetic lysine analog that inhibits brinolytic activity by competitively inhibiting the binding of plasminogen to brin, thereby inhibiting brinolysis and reducing perioperative blood loss. Chen et al [12] conducted a meta-analysis using TXA in TKA and THA, and concluded that intravenous use of TXA can reduce perioperative blood loss, which is worthy of clinical recommendation. A multicenter retrospective study on simultaneous bilateral knee replacement surgery reported that intravenous use of TXA is safe and effective, and reduces perioperative blood loss without increasing complications [16].…”

“…Several studies have reported that perioperative intravenous infusion of TXA can reduce total blood loss, intraoperative blood loss, and blood transfusion rate during joint replacement surgery, and that it does not increase the risk of venous thrombosis. Its safety has been recognized by clinical experts [4][5][6][7]. fracture surgery.…”

Intravenous administration of tranexamic acid to reduce blood loss during perioperative period in acetabular fracture surgery

“…At present, a large number of studies report that TXA is safe and effective in hip and knee joint replacement, regardless of the mode of administration, intravenous, topical, or combination [11][12][13][14].…”

“…The effectiveness of intravenous use of TXA TXA is a synthetic lysine analog that inhibits fibrinolytic activity by competitively inhibiting the binding of plasminogen to fibrin, thereby inhibiting fibrinolysis and reducing perioperative blood loss. Chen et al [11] conducted a meta-analysis using TXA in TKA and THA, and concluded that intravenous use of TXA can reduce perioperative blood loss, which is worthy of clinical recommendation. A multicenter retrospective study on simultaneous bilateral knee replacement surgery reported that intravenous use of TXA is safe and effective, and reduces perioperative blood loss without increasing complications [15].…”