Evidence map›Paper›PMID 30696680›Full record

SynthesisBMJ open2019

Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials.

Qi Sun, Jinyu Li, Jiang Chen, Chenying Zheng, Chuyin Liu, Yusong Jia

Open access · goldAbstract readComparative StudyMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 6 pooled it
4.7field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 6 syntheses or guidelines pooled it, 90 citations in OpenAlex.

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  18. Does tranexamic acid reliably reduce blood loss in proximal femur fracture surgery?European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Qi Sun *Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Jinyu Li *Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Jiang ChenDepartment of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Chenying ZhengDepartment of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Chuyin LiuDepartment of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Yusong JiaDepartment of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine · CN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis study aimed to compare the effects of intravenous, topical and combined routes of tranexamic acid (TXA) administration on blood loss and transfusion requirements in patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA).

designThis was a meta-analysis of randomised controlled trials (RCT) wherein the weighted mean difference (WMD) and relative risk (RR) were used for data synthesis applied in the random effects model. Stratified analyses based on the surgery type, region, intravenous and topical TXA dose and transfusion protocol were also conducted. The main outcomes included intraoperative and total blood loss volume, transfusion rate, low postoperative haemoglobin (Hb) level and postoperative Hb decline. However, the secondary outcomes included length of hospital stay (LOS) and/or occurrence of venous thromboembolism (VTE).

settingWe searched the PubMed, Embase and Cochrane CENTRAL databases for RCTs that compared different routes of TXA administration.

participantsPatients undergoing TKA or THA.

interventionsIntravenous, topical or combined intravenous and topical TXA.

resultsTwenty-six RCTs were selected, and the intravenous route did not differ substantially from the topical route with respect to the total blood loss volume (WMD=30.92, p=0.31), drain blood loss (WMD=-34.53, p=0.50), postoperative Hb levels (WMD=-0.01, p=0.96), Hb decline (WMD=-0.39, p=0.08), LOS (WMD=0.15, p=0.38), transfusion rate (RR=1.08, p=0.75) and VTE occurrence (RR=1.89, p=0.15). Compared with the combined-delivery group, the single-route group had significantly increased total blood loss volume (WMD=198.07, p<0.05), greater Hb decline (WMD=0.56, p<0.05) and higher transfusion rates (RR=2.51, p<0.05). However, no significant difference was noted in the drain blood loss, postoperative Hb levels and VTE events between the two groups. The intravenous and topical routes had comparable efficacy and safety profiles.

conclusionsThe combination of intravenous and topical TXA was relatively more effective in controlling bleeding without increased risk of VTE.

Indexed as

Administration, IntravenousAdministration, TopicalAnemiaAntifibrinolytic AgentsArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBlood Loss, SurgicalBlood TransfusionHemoglobinsHumansLength of StayPostoperative ComplicationsRandomized Controlled Trials as TopicTranexamic AcidVenous ThromboembolismAntifibrinolytic AgentsHemoglobinsTranexamic AcidIVmeta-analysistopicaltotal hip arthroplastytotal knee arthroplastytranexamic acid

Identifiers

PMID30696680
PMCPMC6352808
OpenAlexW2913195194

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.