Intraarticular versus intravenous tranexemic acid in reducing blood loss after primary total knee arthroplasty

Abstract

Background: One of the substantial complications of total knee arthroplasty is major blood loss. Postoperative blood loss can range up to 2000 ml and 10-38% of patients may require blood transfusion. Among the sundry methods of preventing this prob, tranexamic acid, an anti-fibrinolytic, is one of the most effective options. It can be administered directly into the blood or injected locally. The purpose of this study was to compare the hemostatic effects of intraarticular versus intravenous administration of tranexamic acid in primary total knee arthroplasty. Methods: A prospective comparative observational study was done from done September 2020 to February 2022 at Civil Service Hospital, Kathmandu. 64 patients randomized into two groups: an intraarticular tranexamic acid group (31 patients who received 3.0 grams of intraarticular tranexamic acid) and intravenous tranexamic acid group (31 patients who received 15 mg/kg intravenous tranexamic acid in two instances). The primary measure was the amount of hemoglobin loss. Secondary outcomes included comparison of hemoglobin level pre- and post- operatively at first and fifth day, drain volume at 48 hours and amount of blood transfusion. There were no significant differences in demographics or preoperative laboratory values between the groups. Results: The baseline data, preoperative hemoglobin, and tourniquet time were similar in both groups. Hemoglobin at first and fifth operative day and drain volume at 48 hours were measured in both categories. There was no significant difference in perioperative blood loss, drain volume, rates of allogeneic blood transfusion between the two groups. No any thromboembolic complications occurred. Conclusions: Intra-articular administration of tranexamic acid was found to be as effective and safe as intra-venous administration in reducing blood loss in primary total knee arthroplasty.