BACKGROUND: The prevalence of total knee arthroplasty (TKA) is increasing, which is one of the most frequent operations in orthopedic practice. To further investigate the safe and effective role of using tranexamic acid (TA) in reducing transfusion rate and blood loss in total knee arthroplasty.

MATERIAL AND METHODS: This meta-analysis was conducted according to the Cochrane methodology. Twenty-eight superior quality and well designed randomized controlled trials (RCT) were collected to analyze for this study. Patients who had undergone primary unilateral TKA were chosen. The software, RevMan 5.2, was used to analyze collected data.

RESULTS: Finally, 28 RCTs were collected to analyze for this study. Total blood loss was dramatically decreased via the application of TA, by a mean of 420 ml [95% CI: –514 to –327]. A significant reduction about blood transfusion rate was also found in patients who received TA. [RD: –0.26, 95%CI: –0.33 to –0.19]. Moreover, no significant differences were found between TA and control groups in incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE).

CONCLUSIONS: This meta-analysis demonstrates that the application of TA in TKA could decrease total blood loss and transfusion rate. On the other hand, the application of TA is not associated with high incidence of DVT or other adverse events. TA should be taken into account in routine use in primary knee arthroplasty to benefit the patients.

Keywords: Arthroplasty, Replacement, Knee - methods, Antifibrinolytic Agents - therapeutic use, Blood Loss, Surgical, Blood Transfusion, Data Interpretation, Statistical, Incidence, Orthopedics - methods, Prevalence, Quality Assurance, Health Care, Tranexamic Acid - therapeutic use, Venous Thrombosis - prevention & control