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

IF 4 2区医学 Q1 ORTHOPEDICS

Efort Open Reviews Pub Date : 2025-10-01 DOI:10.1530/EOR-2025-0027

Yongjian Wang, Xinyu Na, Tong Chen, Lingqin Huang, Cong Chen, Hainan Hong

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Abstract

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.

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口服氨甲环酸与静脉注射氨甲环酸用于全膝关节置换术围手术期血液管理的证据：一项系统回顾和荟萃分析。

目的：本研究旨在系统评价口服与静脉注射氨甲环酸（TXA）在全膝关节置换术（TKA）中的疗效和安全性。方法：根据系统评价和荟萃分析首选报告项目（PRISMA） 2020指南进行审查过程。检索了PubMed、EMBASE、Web of Science和Cochrane Library。数据提取和质量评估由两名调查员独立完成。主要结局是血红蛋白（Hb）下降和失血，次要结局包括输血率、手术时间、住院时间和并发症。分析采用随机效应模型，用i2值评估异质性。结果：荟萃分析包括9项研究，共1227名参与者。在纳入的研究中，术前1-2小时口服TXA最常见的剂量为1.95-2 g，一些方案包括术后剂量。术前静脉注射TXA通常为1g，有时在伤口愈合前或手术后再加剂量。结果显示口服和静脉注射TXA在Hb降低和输血率方面没有显著差异。同样，两组在并发症、手术时间和住院时间方面也无显著差异。在随机对照试验和非随机对照试验中均观察到类似的结果。敏感性分析表明，总体结果仍然稳健，没有任何一项研究对汇总估计值产生实质性影响。结论：根据现有证据，TKA患者口服和静脉注射TXA无显著差异。然而，一些结果的宽置信区间表明了重要的不确定性，需要进一步的高质量研究来确认相对有效性和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Efort Open Reviews Medicine-Orthopedics and Sports Medicine

CiteScore

6.60

自引率

2.90%

发文量

101

审稿时长

13 weeks

期刊介绍： EFORT Open Reviews publishes high-quality instructional review articles across the whole field of orthopaedics and traumatology. Commissioned, peer-reviewed articles from international experts summarize current knowledge and practice in orthopaedics, with the aim of providing systematic coverage of the field. All articles undergo rigorous scientific editing to ensure the highest standards of accuracy and clarity. This continuously published online journal is fully open access and will provide integrated CME. It is an authoritative resource for educating trainees and supports practising orthopaedic surgeons in keeping informed about the latest clinical and scientific advances. One print issue containing a selection of papers from the journal will be published each year to coincide with the EFORT Annual Congress. EFORT Open Reviews is the official journal of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and is published in partnership with The British Editorial Society of Bone & Joint Surgery.