Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4210-4220
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4210
Efficacy of topical vs intravenous tranexamic acid in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis
Jian-Wen Xu, Hong Qiang, Ting-Li Li, Yi Wang, Xiao-Xiao Wei, Fei Li
Jian-Wen Xu, Hong Qiang, Ting-Li Li, Xiao-Xiao Wei, Nursing Department, Yangpu District Shidong Hospital, Shanghai 200438, China
Yi Wang, Emergency Services Department, Yangpu District Shidong Hospital, Shanghai 200438, China
Fei Li, The Second Neurological Department, Yangpu District Shidong Hospital, Shanghai 200438, China
Author contributions: Xu JW and Li F conceptualized this study; Xu JW, Qiang H, and Li F collected the data; Xu JW, Wang Y, and Wei XX performed the formal analysis; Xu JW and Wang Y drafted the manuscript; Li F edited and reviewed the manuscript.
Conflict-of-interest statement: There are no conflicts of interest of any authors in relation to the submission of this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei Li, MD, Chief Doctor, The Second Neurological Department, Yangpu District Shidong Hospital, No. 999 Shiguang Road, Yangpu District, Shanghai 200438, China. lifeimedicine@163.com
Received: December 24, 2020
Peer-review started: December 24, 2020
First decision: January 7, 2021
Revised: February 24, 2021
Accepted: March 29, 2021
Article in press: March 29, 2021
Published online: June 16, 2021
Processing time: 152 Days and 23.7 Hours
Abstract
BACKGROUND

Tranexamic acid (TXA) has been used as an anti-fibrinolytic drug for over half a century and has received much attention in recent decades.

AIM

To evaluate the efficacy of topical vs intravenous TXA in reducing blood loss and promoting wound healing in bone surgery.

METHODS

From the electronic resources, PubMed, Cochrane Library, Embase, ISI, and Scopus were used to perform a literature search over the last 10 years between 2010 and 2020. EndNote™ X8 was used for managing the electronic resource. Searches were performed with mesh terms. The data were retracted blindly by two independent reviewers. Random effects were used to deal with potential heterogeneity and I2 showed heterogeneity. Chi-square (I2) tests were used to quantify the extent of heterogeneity (P < 0.01 was considered statistically significant). The efficacy of topical TXA in reducing blood loss and promoting wound healing in bone surgery was compared with intravenous TXA and placebo.

RESULTS

According to the research design, 1360 potentially important research abstracts and titles were discovered in our electronic searches, and 18 papers remained in agreement with our inclusion criteria. It was found that TXA reduced 277.51 mL of blood loss compared to placebo, and there was no significant difference between topical TXA and IV TXA in reducing blood loss in bone surgery. Our analyses also showed that TXA significantly reduced blood transfusion compared to placebo and there was no significant difference between topical TXA and IV TXA.

CONCLUSION

The use of both topical and intravenous TXA are equally effective in reducing blood loss in bone surgery, which might be beneficial for wound healing after surgery.

Keywords: Tranexamic acid; Blood loss; Wound healing; Bone surgery; Meta-analysis

Core Tip: Although tranexamic acid (TXA) is regularly used by surgeons, a comprehensive guideline on safe topical doses and methods for TXA administration has remained controversial. This study showed that both topical and intravenous TXA are equally effective in reducing blood loss in bone surgery, which is thus beneficial for wound healing after surgery.