Efficacy and Safety of Oral versus Intravenous Administration of Tranexamic Acid in Elective Total Hip Arthroplasty: A Systematic Review and Meta-Analyses of Randomized Controlled Trials.

Abstract

Oral tranexamic acid (TXA) is proposed as an alternative to intravenous (IV) use to reduce blood loss in total hip arthroplasty (THA). However, its cost-effectiveness and safety remain uncertain. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of oral versus IV prophylactic administration of TXA among patients undergoing elective THA. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and was registered in The International Prospective Register of Systematic Reviews database. We searched several bibliographic databases for randomized controlled trials comparing oral to IV TXA administration in patients undergoing THA. Primary outcomes included intraoperative blood loss, while secondary outcomes covered transfusion rates, length of hospital stay, postoperative complications within 30 days (thromboembolic events, infections, hospital readmission), and treatment cost. There were nine randomized controlled trials involving 1,060 patients included. Meta-analysis revealed that there were no significant differences between the total blood loss groups (mean difference = -3.04, 95% confidence interval (CI) (-39.54 to 33.47), P = 0.97). Furthermore, there were no significant differences in transfusion rates (odds ratio = 1.04, 95% CI (0.54 to 1.99), P = 0.92), length of hospital stays (mean difference = 0, 95% CI (-0.03 to 0.03), P = 0.89), and postoperative complications. However, oral TXA was associated with a lower cost. In the subgroup analysis, we found a higher reduction in hemoglobin in the oral TXA group for multiple doses. Our findings suggest that in patients undergoing THA, oral administration of TXA, compared to IV administration, has similar clinical results, but with lower treatment costs.