Intravenous versus topical tranexamic acid adminis

Authors: YoungSoo Shin JungRo Yoon HoonNyun Lee SeHwan Park DaeHee Lee

Publish Date: 2016/07/14

Volume: 25, Issue: 11, Pages: 3585-3595

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Abstract

This metaanalysis was designed to compare the effectiveness and safety of intravenous IV versus topical administration of tranexamic acid TXA in patients undergoing primary total knee arthroplasty TKA by evaluating the need for allogenic blood transfusion incidence of postoperative complications volume of postoperative blood loss and change in haemoglobin levelsStudies were included in this metaanalysis to check whether they assessed the allogenic blood transfusion rate postoperative complications including pulmonary thromboembolism PTE or deep vein thrombosis DVT volume of postoperative blood loss via drainage estimated blood loss total blood loss and change in haemoglobin levels before and after surgery in primary TKA with TXA administered through both the IV and topical routesTen studies were included in this metaanalysis The proportion of patients requiring allogenic blood transfusion OR 134 95  CI 063–281 ns and the proportion of patients who developed postoperative complications including PTE or DVT OR 085 95  CI 041 to 177 ns did not significantly differ between the two groups There was 523 mL less blood loss via drainage 95  CI −5074 to 18566 mL ns 521 mL greater estimated blood loss 95  CI −15527 to 5103 mL ns and 514 mL greater total blood loss 95  CI −20816 to 10531 mL ns in the topical TXA group as compared to the IV TXA group The two groups were also similar in terms of the change in haemoglobin levels 002 g/dL 95  CI −036 to 039 g/dL nsIn primary TKA there are no significant differences in the transfusion requirement postoperative complications blood loss and change in haemoglobin levels between the IV and topical administration of TXA In addition results from subgroup analysis evaluating the effect of the times of TXA administration through the IV route suggested that double IV dose of TXA is more effective than single dose in terms of the transfusion requirements and blood loss via drainage The current metaanalysis indicates that IV administration of 10 mg/kg of TXA 20 min before inflation of the tourniquet followed by 10 mg/kg of TXA 15 min before deflation of the tourniquet is effective and safe The topical administration of 2 g of TXA mixed with 100 mL of normal saline after wound closure could be an alternative option in patients at greater risk of thromboembolic complications

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