A comparison of efficacy and safety of oral versus intravenous applications of tranexamic acid in total hip and knee arthroplasty: an updated systematic review meta-analysis of randomized controlled trials.

BACKGROUND

Tranexamic acid (TXA) has been extensively used in total hip and total knee arthroplasty (THA and TKA) to reduce blood loss. The commonly investigated routes of TXA administration include oral, intravenous, intra-articular, and topical methods. However, the ideal route of administration remains controversial. The objective of this study was to evaluate and compare the efficacy and safety of oral versus intravenous tranexamic acid in primary total knee and hip arthroplasty.

METHODS

The PubMed, Web of Science, Cochrane Library and Embase databases were systematically searched for relevant randomized controlled trials (RCTs) which updated on October 2024. Decline of hemoglobin (DHB), total blood loss (TBL), length of hospital stays (HS), intra-operative blood loss (IBL), operative time, transfusion rate, deep vein thrombosis (DVT) and intramuscular venous thrombosis (IVT) were extracted and analyzed. Sensitivity analyses were conducted for each outcome based on the degree of heterogeneity. Furthermore, we assessed publication bias through funnel plots, Egger tests and the trim-and-fill method. The study adhered to PRISMA and AMSTAR guidelines. All of the analyses were performed using Review Manager (RevMan) 5.4 and Stata 15.0 software.

RESULTS

A total of 2,262 patients from 16 randomized controlled trials (RCTs) were ultimately included in the meta-analysis. No statistically significant differences were observed in terms of decline of hemoglobin (P = 0.95), total blood loss(P = 0.59), length of hospital stays (P = 0.28), intra-operative blood loss (P = 0.64), operative time (P = 0.67), transfusion rate (P = 0.96), deep vein thrombosis (P = 0.14), intramuscular venous thrombosis (P = 0.14) between the oral and intravenous groups. But five studies reported that oral TXA has lower cost than intravenous.

CONCLUSION

This meta-analysis provided updated evidence that suggests oral and intravenous TXA have similar efficacy and safety. However, oral tranexamic acid can reduce financial burden of joint replacement on patients. So more high-quality RCTs are needed to confirm that oral may be the ideal route of administration for TXA.