Efficacy and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
Cihan Yazar, Suat Morkuzu, Mehmet Fırat Tantekin et al.
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In 30 seconds
This systematic review and meta-analysis pooled randomized controlled trials comparing topical with intravenous tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty. Eleven trials were included. No statistically significant differences were detected in postoperative hemoglobin drop, total blood loss, drainage volume, or transfusion rate. For transfusion, the pooled relative risk was 0.644 (95% CI: 0.343 to 1.209, P = 0.171). The authors emphasize substantial uncertainty, particularly for safety and thromboembolic outcomes.
Key findings
- Postoperative hemoglobin drop did not differ significantly between routes (9 studies, 815 patients; SMD = -0.292, 95% CI: -0.748 to 0.163, P = 0.208).
- No significant difference was found in total blood loss (5 studies, 418 patients; SMD = 0.356, 95% CI: -0.297 to 1.009, P = 0.284).
- Transfusion rates were not significantly different (10 studies, 914 patients; RR = 0.644, 95% CI: 0.343 to 1.209, P = 0.171).
- Usable DVT data came from seven studies; only one DVT event was reported, in the IV group.
Why it matters
TXA is used to reduce bleeding in total knee arthroplasty, and the choice of administration route may affect clinical decisions. This pooled comparison found no clear advantage for topical or intravenous administration on the reported blood-conservation outcomes. However, the estimates remain uncertain, and sparse thromboembolic reporting means the evidence does not establish comparable safety.
What to keep in mind
Safety evidence was limited: usable DVT data were available from only seven studies, four studies did not report or state thromboembolic or adverse events, and only one DVT event was reported.