Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

Yiming Qi; Yingjuan Li; Chen Wang; Hui Chen; Yunfeng Rui

doi:10.1186/s42836-020-00027-7

April 8, 2020ArthroplastyOpen Access

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

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Why the study?

Total hip arthroplasty is associated with substantial blood loss leading to postoperative anemia, prompting a comparison of the efficacy and safety of oral versus intravenous tranexamic acid.

Does oral tranexamic acid reduce blood loss and transfusion rates as effectively as intravenous tranexamic acid in patients undergoing total hip arthroplasty?

Key Points

To compare the clinical efficacy and safety of oral versus intravenous tranexamic acid in patients undergoing total hip arthroplasty.
Systematic search of PubMed, EMBASE, and Cochrane Library conducted from inception through December 2019.
Identified and included five randomized controlled trials comparing oral tranexamic acid to intravenous tranexamic acid.
Assessed outcomes including total blood loss, hemoglobin drop, allogeneic transfusion rate, and thromboembolic complications using Review Manager 5.3.
Oral and intravenous tranexamic acid produced comparable total blood loss (MD = 3.01, 95% CI: -43.90 to 49.92, p = 0.90) and hemoglobin drop (MD = 0.05, 95% CI: -0.10 to 0.20, p = 0.50).
No significant differences were observed between routes for allogeneic blood transfusion rates (RR = 1.09, 95% CI: 0.46 to 2.62, p = 0.84) or postoperative thromboembolic complications (RR = 1.71, 95% CI: 0.71 to 4.16, p = 0.97).

Structured PICO

Does oral tranexamic acid reduce blood loss and transfusion rates as effectively as intravenous tranexamic acid in patients undergoing total hip arthroplasty?

P

Population

Patients undergoing total hip arthroplasty (5 RCTs)

I

Intervention

Oral tranexamic acid (TXA)

C

Comparator

Intravenous tranexamic acid (TXA)

O

Outcome

Total blood losssurrogate

Oral tranexamic acid is as effective as intravenous administration in reducing blood loss and transfusion requirements in total hip arthroplasty, without increasing thromboembolic risk.

Implication

Supports oral TXA substitution for IV in THA to simplify dosing; confirms equivalence across aggregated RCTs.

Abstract

BACKGROUND: Total hip arthroplasty is associated with substantial blood loss which can lead to postoperative anemia. The purpose of this systematic review and meta-analysis was to compare efficacy and safety of oral tranexamic acid (TXA) and intravenous TXA. METHODS: PubMed, EMBASE, and Cochrane Library were searched from inception until December 2019. A combined searching strategy of subject words and random words was adopted. Only clinical randomized controlled trials were included. The comparisons were made with regard to total blood loss, hemoglobin drop, transfusion rate, and postoperative thromboembolic complications including deep vein thrombolism (DVT) and pulmonary embolism (PE). The meta-analysis was conducted by using the Review Manager 5.3, and bias evaluation was performed based on the Cochrane Handbook 5.1.0. RESULTS: In this meta-analysis, five randomized controlled trials were included. The results showed that there were no significant differences between the oral TXA group and intravenous TXA group concerning total blood loss [mean difference (MD) =3.01, 95% confidence interval (95% CI): - 43.90 to 49.92, p = 0.90], hemoglobin drop (MD = 0.05, 95% CI: - 0.10 to 0.20, p = 0.50) and transfusion rate of allogeneic blood [risk ratio (RR) =1.09, 95% CI: 0.46 to 2.62, p = 0.84]. No significant difference was found in the incidence of thromboembolic events (RR = 1.71, 95% CI: 0.71 to 4.16, p = 0.97). CONCLUSIONS: Compared with intravenous TXA, oral TXA is equally able to reduce total blood loss, hemoglobin drop, and transfusion requirement for total hip arthroplasty. It is a lower-cost method that does not increase the incidence of thromboembolic events.