Oral tranexamic acid can reduce blood loss after total knee and hip arthroplasty: A meta-analysis

The aim of the present study was to compare the efficacy and safety of oral tranexamic acid (TXA) with controls or intravenous TXA in patients undergoing total joint arthroplasty (TJA) in a systematic review and meta-analysis.

We systematically searched randomized controlled trials (RCTs) from PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Google databases. Any studies comparing oral TXA versus a control group or intravenous TXA for patients prepared for TJA were included. The outcomes included the need for transfusion, hemoglobin drops, length of hospital stay and drain volume. We calculated the risk ratio (RR) with a 95% confidence interval (CI) for the need of transfusion and the weighted mean difference (WMD) with a 95% CI for hemoglobin drop, length of hospital stay and drain blood loss. Stata 12.0 was used for the meta-analysis.

Five clinical trials (5 RCTs) involving 333 patients were finally included in this meta-analysis. When compared with the control group, oral TXA was associated with less need for transfusion, fewer hemoglobin drops, less drain volume and a shorter length of hospital stay (P < 0.05). When compared with IV TXA, oral TXA was associated with more hemoglobin drops (P < 0.05). However, there was no significant difference between the need for transfusion, drain volume and the length of hospital stay between oral TXA and IV TXA.

Oral TXA has comparable hemostatic effects with IV TXA and may reduce the costs for patients prepared for TJA. However, considering the limited quality and number of the included studies, more high-quality and multi-center RCTs are still needed to recommend oral TXA for routine administration.