The efficiency and safety of oral tranexamic acid in total hip arthroplasty: A meta-analysis

BACKGROUND: Intravenous (IV), topical and combination of both application of tranexamic acid (TXA) can reduce blood loss, hemoglobin drop, and transfusion rate in patients following total hip arthroplasty (THA). Lately, published articles reported that oral TXA had as similar blood-saving as IV and topical TXA in THA. The purpose of this meta-analysis is to investigate the efficiency and safety of oral TXA in THA. METHODS: We systematically searched articles about oral administration of TXA in THA from PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Chinese Wanfang database. Study eligibility criteria: 1. Patients underwent primary THA; 2. The intervention was oral application of TXA in THA; 3. Outcomes included hemoglobin drop, total blood loss, transfusion rate, length of stay, and complications; 4. The studies were designed as randomized controlled trials (RCTs) or clinical comparative trial (CCT). The outcomes were collected and analyzed by the Review Manager 5.3. RESULTS: Nine RCTs and 1 CCT, containing 1305 patients, were ultimately included according to the inclusion criteria and exclusion criteria in the meta-analysis. The effectiveness of oral TXA was as similar as the IV or topical TXA in regard to hemoglobin drop (SMD = −0.14; 95% CI, [−0.28, 0.01]; P = .06), total blood loss (SMD = 0.01; 95% CI, [−0.13, 0.16]; P = .84), transfusion rate (OR = 0.76; 95% CI, [0.38, 1.55]; P = .37). Compared with single oral TXA or blank group, multiple oral TXA effectively reduced hemoglobin drop (SMD = −1.06; 95% CI, [−1.36, −0.77]; P < .05), total blood loss (SMD = −1.30; 95% CI, [−1.66, −0.94]; P < .05), transfusion rate (OR = 0.53; 95% CI, [0.29, 0.95]; P = .03). There were no significant difference in terms of length of stay and complication among all of enrolled studies. CONCLUSION: Oral TXA has favorable effect of blood-saving and do not increase risk of complication in patients following THA. Oral TXA may have no effect in the length of stay. More high quality RCTs are necessary.