A Comparison Of Combined Intravenous And Topical Administration Of Tranexamic Acid Versus Intravenous Administration Alone In TKA:a Meta-analysis Of Randomized Controlled Trial

BackgroundTotal knee arthroplastγ(TKA)is one of the most effective treatments for many patients with end-stage knee diseases.However,TKA can lead to severe blood loss during and after operation,leading to a large number of clinical blood transfusion,which will seriously affect the rehabilitation of patients and functional exercise after operation.At the same time,there will also be adverse complications such as infectious diseases,severe allergic reactions and so on,leading to surgical results less than expected.Therefore,how to minimize operative blood loss without increasing adverse thromboembolic events(DVT,PE)is a clinical problem that must be paid attention to.In recent years,tranexamic acid(TXA)has been widely used in various orthopaedic operations,especially in joint replacement surgery.By inhibiting the activation of plasminogen,TXA plays an important role in reducing blood loss during and after surgery.At present,TXA is routinely used by intravenous drip or local injection,but the optimal application of tranexamic acid remains controversial.Recently,combined Intravenous and topical application of TXA has gradually appeared in the major literature,and has attracted wide attention.ObjectiveThrough high-quality literature search and meta-analysis to analyze various intraoperative and postoperative blood loss indicators,and the occurrence of adverse complications;To explore whether combined Intravenous and topical application of TXA is superior to intravenous application of tranexamic acid alone.MethodsA systematic literature search scheme is applied to PubMed,Medline,Embase,Web of Science,the Cochrane Library,China Wanfang database,China National Knowledge Internet,and Sinomed.Only high-quality randomized controlled trials were included in the study.The results included total blood loss,intraoperative blood loss,overt blood loss,hidden blood loss,drainage volume,hemoglobin decline,transfusion rate,and the occurrence of DVT.Reman5.1 software was used to complete this meta-analysis.ResultsA total of 15 high-quality randomized controlled trials including 1333 patients were involved,655 patients in the experimental group and 678 patients in the control group.Accurate analysis showed that the experience group had less total blood loss(MD=-122.05,95%CI:-160.81 to-83.28,P<0.00001),hidden blood loss(MD=-77.71,95%CI:-112.73 to-42.68,P=0.0004),drainage volume(MD=-78.80,95%CI:-106.30 to-51.30,P<0.00001),hemoglobin decline(MD=-6.84,95%CI:-12.42 to-1.25,P=0.02),and transfusion rate(RR=0.36,95%CI:0.20 to 0.62,P=.0003),but no significant difference in intraoperative blood loss(MD=2.95,95%CI:-4.99 to 10.89,P=0.47),overt blood loss(MD=-57.19,95%CI:-125.14 to 10.76,P=0.1),the occurrence of DVT(RR=0.88,95%CI:0.32 to 2.37,P= 0.80).ConclusionThis Meta analysis showed that intravenous combined local application of TXA had a better hemostatic effect than intravenous administration alone,and most importantly,there was no significant increase in side effects.Therefore,it is recommended that vein combined with local application of TXA to achieve better hemostatic effect.It is hoped that large-scale randomized controlled studies will be available to confirm the conclusions of this analysis.