A Single Preoperative Dose and an Additional Dose of Tranexamic Acid in Total Knee Arthroplasty: a Meta-analysis

Objective: To review the efficacy and safety of a single preoperative dose and an additional postoperative dose of tranexamic acid (TXA) in reducing blood loss in total knee arthroplasty (TKA). Methods: PubMed, Embase, Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs) in March 2021. Postoperative blood loss, transfusion rate, and deep vein thrombosis (DVT) incidence were studied. Data were analyzed using Review Manager 5.3 software and Stata 14.0 software. Results: : Intravenous (IV) TXA twice provided lower postoperative blood loss compared with placebo group (P＜0.001) and IV TXA once group (P=0.007), but a higher postoperative blood loss as compared with combined TXA (P＜0.001). IV TXA twice provided lower transfusion rate compared with placebo group (P＜0.001). No significant difference was found in terms of DVT incidence (P＞0.05). There was no significant publication bias for postoperative blood loss, transfusion rate, and DVT incidence. Conclusion: When it comes to IV TXA in TKA, a single preoperative dose and an additional dose of TXA may be a better and more feasible way for blood control than a single preoperative dose.