Multiple doses versus single dose of intravenous tranexamic following total joint arthroplasty : a meta-analysis of randomized controlled trials

Background: The use of intravenous tranexamic acid (TXA) in total joint arthroplasty (TJA) has been proven effective and safe. However, the optimal dose remains controversial. The principal objective of this meta-analysis was to compare the efficacy and safety of multiple doses with a single dose of intravenous TXA in patients following total knee and hip arthroplasty (TKA and THA). Methods: Electronic databases were searched, including PubMed, Web of Science, EMBASE, Cochrane Library, the Chinese Biomedical Literature database, Wanfang database, and CNKI database, from 1966 to October 2017. Randomized control trials (RCTs) of patients undergoing TJA that compared multiple doses with a single dose of intravenous TXA were retrieved. Primary outcomes included hidden blood loss (HBL) and transfusion rates, along with incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). Secondary outcomes included total blood loss (TBL), postoperative drainage volume (day 1 and day 2 after surgery), and length of hospital stay (LOH). All data were analyzed using RevMan 5.3 software. Result: At total of 17 RCTs, involving 1,767 patients, were included. The current meta-analysis showed that TBL, HBL, transfusion rates, and postoperative drainage volume were significantly lower in patients receiving multiple doses of intravenous TXA, compared to a single dose. LOH also seemed to be shorter in the multiple-dose group. No statistical differences were found in incidence of DVT or PE. Conclusion: This meta-analysis demonstrates that multiple doses may be superior to a single dose of intravenous TXA for patients undergoing TJA.

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