Systematic review and meta-analysis of intravenous and topical tranexamic acid in reducing blood loss in knee arthroplasty

InTrodUcTIon: The purpose of this review and meta-analysis is to compare tranexamic acid (TXA) administration via the intravenous route (IV-TXA) and topical route (T-TXA), in reducing blood loss in knee arthroplasty. MATerIAL And MeTHods: A systematic literature search was performed using Medline, EMBASE, Scopus and CENTRAL databases till December 20, 2021. Outcomes of interest included blood loss, hematocrit and hemoglobin drop, and adverse events. resULTs: A total of 3,363 patients (n = 1,307 in IV-TXA group; n = 2,056 in T-TXA group) from 23 studies were included. There was no statistically significantly difference between IV-TXA and T-TXA among to: total blood loss (874.8 ± 349.7 mL vs 844.9 ± 366.6 mL, respectively; SMD = 0.13; 95% CI: −9.37 to 85.32; p = 0.15), as well as transfusion needed (10.9% vs 15.4% respectively (RR = 0.79; 95% CI: 0.60 to 1.04; p = 0.09). Blood loss from the drain in IV-TXA and T-TXA varied and occurred 377.9 ± 191.9 vs 302.9 ± 182.6 mL for IV-TXA and T-TXA, respectively: (SMD = 0.52; 95% CI: 0.02 to 1.02; p = 0.04). concLUsIons: Our clinical findings support that TXA can effectively, safely, and decrease the number of transfusions without severe side effects in patients undergoing TKA. However, given the reports from individual single clinical trials of the superiority of T-TXA, further clinical trials and meta-analyses based on these findings are needed to standardize the approach to TXA use in patients undergoing knee arthroplasty.