Combined intravenous and intraarticular tranexamic acid compared with intraarticular use alone in total knee arthroplasty: A randomized controlled trial

Abstract

: Total knee arthroplasty is associated with high rates of blood loss during and after the surgery. Tranexamic acid is an antifibrinolytic agent that effectively reduces total blood loss in total knee arthroplasty and minimizes the need for blood transfusion and transfusion-related complications. However, the most efficacious route of tranexamic acid administration has not been established. Therefore, in this study, we aimed to compare combined intravenous and intraarticular tranexamic acid with intraarticular use alone in patients undergoing total knee arthroplasty.In this randomized, double-blind clinical trial, 104 patients scheduled for primary unilateral Total knee arthroplasty were randomized to one of the two intervention groups. The combined intravenous and intraarticular group received 15 mg/kg (Max dose of 1 g) of intravenous tranexamic acid along with 15 mg/kg (Max dose of 1 g) of tranexamic acid administered intraarticularly after the capsule and retinaculum closure. Total blood loss was calculated using the drop in hemoglobin at post-operative day 3. The transfusion rate and incidence of thromboembolic events were evaluated.Total blood loss in patients receiving combined intravenous and intraarticular tranexamic acid was not significantly different from that in patients receiving only intraarticular tranexamic acid (926 ± 312 ml vs 905 ± 348 ml, p value= 0.824). There were no complications like thromboembolic events or wound infection. In conclusion, the intraarticular administration of tranexamic acid is an equally effective route as combined intravenous and intraarticular use of tranexamic acid in total knee arthroplasty, and hence to avoid potential complications of systemic TXA use, we recommend using the intraarticular only tranexamic acid in total knee arthroplasty.