The efficacy and safety of oral tranexamic acid for reducing blood loss after total joint arthroplasty: a meta-analysis

Objective: This meta-analysis aimed to illustrate the efficacy and safety of oral tranexamic acid (TXA) for reducing blood lossafter total joint arthroplasty (TJA). Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Google database were searched for comparative studies comparing oral TXA versus control group or intravenous TXA for patients prepared for TJA. The outcomes including need for transfusion, hemoglobin drop, length of hospital stay and drain volume. We calculated risk ratio (RR) with a 95% confidence interval (CI) for need for transfusion, and the weighted mean difference (WMD) with a 95% CI for hemoglobin drop, length of hospital stay and drain volume. A random-effects model was used for all comparisons and Stata 12.0 was used for meta-analysis. Results: Six clinical trials (4 RCTs and 2 non-RCTs) involving 3258 patients were finally included for this meta-analysis. When compared with control group, oral TXA was associated with less need for transfusion, hemoglobin drop, drain volume and length of hospital stay (P<0.05). When compared with IV TXA, oral TXA was associated with more hemoglobin drop (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 with IV TXA. Conclusion: Oral TXA has comparable hemostasis effects with IV TXA, and may reduce the costs for patients prepared for TJA. However, the limited quality and number of the included studies, more high quality and multi center RCTs are still need to recommend for routine administration.