• Hamidreza Shemshaki, Sayed Mohammad Amin Nourian, Niloofaralsadat Nourian, Masoudhatef Dehghani, Masoud Mokhtari, and Farhad Mazoochian.
• Orthopaedic Surgery Department, Crona Clinik, Eberhard Karls University, Tuebingen, Germany, Hamidrezashemshaki@yahoo.com.
• Arch Orthop Trauma Surg. 2015 Apr 1;135(4):573-88.

BackgroundTranexamic acid (TXA) in orthopedics has recently been gaining favor due to its efficacy and ease of use, both in intravenous (IV) and intraarticular (IA) usage. However, because of safety concerns with IV administration, there has been a growing interest in the IA use of TXA to prevent bleeding.Materials And MethodsThis study conducted a systematic review and meta-analysis that included 31 randomized, controlled trials in which the effect of systemic and topical TXA on total blood loss (TBL), rates of transfusion, and thromboembolic events was investigated.ResultsCompared to the control, the IA administration of TXA led to the significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and reduction of rate of thromboembolic events (p = 0.29). Compared to the control group, the IV administration of TXA resulted in significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and rate of thromboembolic events (p = 0.66). Although no significant differences in efficacy and safety between the IA and IV administration of TXA were found, the IA method was safer than the IV method in that it reduced rate of transfusion and thromboembolic events.ConclusionThis study showed that TXA leads to significant reductions in TBL and the rate of allogeneic transfusions. Generally, no significant difference was detected between IA and IV administration of TXA; however, more studies with focus on safety and efficacy are warranted.

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