Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

Abstract

Background: Total hip arthroplasty is associated with substantial blood loss which can lead to postoperative anemia. The purpose of this systematic review and meta-analysis was to compare efficacy and safety of oral tranexamic acid (TXA) and intravenous TXA. Methods: PubMed, EMBASE, and Cochrane Library were searched from inception until December 2019. A combined searching strategy of subject words and random words was adopted. Only clinical randomized controlled trials were included. The comparisons were made with regard to total blood loss, hemoglobin drop, transfusion rate, and postoperative thromboembolic complications including deep vein thrombolism (DVT) and pulmonary embolism (PE). The meta-analysis was conducted by using the Review Manager 5.3, and bias evaluation was performed based on the Cochrane Handbook 5.1.0. Results: In this meta-analysis, five randomized controlled trials were included. The results showed that there were no significant differences between the oral TXA group and intravenous TXA group concerning total blood loss [mean difference (MD) =3.01, 95% confidence interval (95% CI): − 43.90 to 49.92, p = 0.90], hemoglobin drop (MD = 0.05, 95% CI: − 0.10 to 0.20, p = 0.50) and transfusion rate of allogeneic blood [risk ratio (RR) =1.09, 95% CI: 0.46 to 2.62, p = 0.84]. No significant difference was found in the incidence of thromboembolic events (RR = 1.71, 95% CI: 0.71 to 4.16, p = 0.97). Conclusions: Compared with intravenous TXA, oral TXA is equally able to reduce total blood loss, hemoglobin drop, and transfusion requirement for total hip arthroplasty. It is a lower-cost method that does not increase the incidence of thromboembolic events.

Efficacy and Safety of Oral Tranexamic Acid vs. Other Routes in Total Joint Arthroplasty

“…The systematic review and meta-analysis of Qi et al compared the efficacy and safety of oral and IV TXA with 5 RCTs. They showed no significant differences between the oral and IV TXA in total blood loss, transfusion rate, or thromboembolic events 60 . Our findings are consistent with previous meta-analyses and systematic reviews.…”

Efficacy and Safety of Orally and Intravenously Administration of Tranexamic Acid in Patients with Elderly Femoral Neck Fracture

“…A population‐based study including 153,169 hip fracture patients reported that the application of TXA decreased 17% of blood transfusion rates and did not increase the risk of perioperative complications, However, the optimal route of TXA administration remain unclear. Compared with traditional intravenous (IV) use of TXA, oral application has been investigated in recent studies 11–13 . A randomized clinical trial including 100 patients undergoing THA suggested oral application of TXA have same efficacy in reducing perioperative blood loss compared with IV (863.3 ± 272.5 mL vs 886.1 ± 200.2 mL, p = 0.66).…”

“…Compared with traditional intravenous (IV) use of TXA, oral application has been investigated in recent studies. 11 , 12 , 13 A randomized clinical trial including 100 patients undergoing THA suggested oral application of TXA have same efficacy in reducing perioperative blood loss compared with IV (863.3 ± 272.5 mL vs 886.1 ± 200.2 mL, p = 0.66). Some studies have studied the IV and local use of TXA in elderly femoral neck fracture patients, 14 , 15 while effectiveness and safety of oral application remain unclear.…”