Evidence on oral tranexamic acid versus intravenous tranexamic acid for perioperative blood management in total knee arthroplasty: a systematic review and meta-analysis

Purpose This study aimed to systematically evaluate the efficacy and safety of oral versus intravenous tranexamic acid (TXA) in total knee arthroplasty (TKA). Methods The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched. Data extraction and quality assessment were performed independently by two investigators. The primary outcomes were hemoglobin (Hb) decrease and blood loss, while secondary outcomes included transfusion rate, operation time, hospital stay, and complications. The analysis used random-effects models and assessed heterogeneity with I 2 values. Results Nine studies were included in the meta-analysis, comprising a total of 1,227 participants. Across the included studies, oral TXA was most commonly administered as 1.95–2 g given 1–2 h before surgery, with some regimens including postoperative doses. Intravenous TXA was typically given as 1 g before surgery, sometimes with additional doses before wound closure or after surgery. The results showed no significant difference between oral and intravenous TXA in terms of Hb decrease and transfusion rates. Similarly, there was no significant difference in complications, operation time, and length of hospital stay. Comparable findings were observed in both RCTs and non-RCTs. Sensitivity analysis demonstrated that the overall results remained robust, with no single study exerting a substantial influence on the pooled estimates. Conclusions Based on available evidence, there is no significant difference observed between oral and intravenous TXA in patients undergoing TKA. However, the wide confidence intervals for several outcomes indicate important uncertainty, and further high-quality studies are needed to confirm the comparative effectiveness and safety.