Abstract
To determine the most effective administration of tranexamic acid (TXA) in patients with primary total knee arthroplasty (TKA). We enrolled a total of 400 patients (154 men and 346 women) in this randomized trial (4 groups, each of 100 patients). The first group (IV1) had a single intravenous dose (15 mg TXA/kg) prior to skin incision. Group 2 (IV2) had TXA in 2 intravenous doses (15 mg TXA/kg): prior to skin incision and 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 mL of saline irrigated topically at the end of the surgery. The fourth group (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. The amount of TBL was significantly lower in IV1, IV2 and COMB regimens compared to the TOP (P<0.0001). The lowest decrease in haemoglobin within 12 hours after surgery was observed in intravenous regimens (P=0.045). A significant difference in haemoglobin decrease on day 1 after the surgery was demonstrated in the COMB and intravenous regimens (P=0.011). In primary TKA, it is preferable to administer TXA intravenously in two doses or in a combined regimen. Simple topical administration of TXA was not as effective and is indicated only in cases where systemic administration of TXA is contraindicated. No substantial complications occurred in either group of patients.
Highlights
Tranexamic acid (TXA) can be administered intravenously, orally or directly into the joint via irrigation in the perioperative period for primary total knee arthroplasty (TKA)
The lowest drainage discharge was achieved in intravenous regimens (IV2 = 350 median Hidden blood loss (mL) and IV1 = 375 mL) and combined administration
Combined administration vs. other regimens We demonstrated that combined administration of TXA leads to significantly lower blood loss to the drainage (P=0.004) and lower total blood loss including the drainage (P=0.015) than topical administration of TXA
Summary
Tranexamic acid (TXA) can be administered intravenously, orally or directly into the joint via irrigation in the perioperative period for primary total knee arthroplasty (TKA) (ref.[1]). There are still concerns about the potential risk of thromboembolic disease in the case of intravenous administration in higher doses[3,4]. For this reason, some studies favour topical administration with the aim of transferring the maximum effect to the target area and avoid an overall effect on the fibrinolytic system[5,6]. It is potentially most effective to combine both routes, to reduce the intravenous dose, thereby minimizing the risk of thromboembolism and increase the effect by additional topical administration[4,5,7]. Even large-scale randomized studies and meta-analyses do not provide consistent conclusions on the proper administration of TXA in terms of dose or number of doses[11]
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