Intravenous tranexamic acid (TXA) has been shown
to be effective in reducing blood loss and the need for transfusion
after joint replacement. Recently, there has been interest in applying
it topically before the closure of surgical wounds. This has the
advantages of ease of application, maximum concentration at the
site of bleeding, minimising its systemic absorption and, consequently,
concerns about possible side-effects. We conducted a systematic review and meta-analysis which included
14 randomised controlled trials (11 in knee replacement, two in
hip replacement and one in both) which investigated the effect of
topical TXA on blood loss and rates of transfusion. Topical TXA
significantly reduced the rate of