Oral vs intravenous tranexamic acid in total-knee arthroplasty and total hip arthroplasty A systematic review and meta-analysis

Background: This study aimed to compare the efficacy and safety of oral tranexamic acid (TXA) with intravenous (IV) TXA in reducing perioperative blood loss in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). Methods: PubMed, Web of Science, Embase, and Cochrane Library were fully searched for relevant studies. Studies comparing the efficacy and safety of oral TXA with IV TXA in TKA and THA were included in this research. Odds ratio (OR) or risk difference (RD) was applied to compare dichotomous variables, while mean difference (MD) was used to compare continues variables. Results: A total of 7 studies (5 randomized controlled trials and 2 retrospective studies) were included into this study. As for patients undergoing TKA or THA, there were no obvious differences between oral TXA group and IV TXA group in hemoglobin (Hb) drop (MD=0.06, 95% confidence interval [CI]=-0.01 to 0.13, P=. 09), transfusion rate (OR=0.78, 95% CI=0.54-1.13, P=. 19), total blood loss (MD=16.31, 95% CI=-69.85 to 102.46, P=. 71), total Hb loss (MD=5.18, 95% CI=-12.65 to 23.02, P=. 57), length of hospital stay (MD=-0.06, 95% CI=-0.30 to 0.18, P=. 63), drain out (MD=21.04, 95% CI=-15.81 to 57.88, P=.26), incidence of deep vein deep vein thrombosis (RD=0.00, 95% CI=-0.01 to 0.01, P=.82) or pulmonary embolism (RD=0.00, 95% CI=-0.01 to 0.01, P=.91). The sample size of this study was small and several included studies were with relatively low quality. Conclusion: Oral TXA is equivalent to IV TXA in reducing perioperative blood loss and should be recommended in TKA and THA. More high-quality studies are needed to elucidate this issue.