Abstract
BackgroundTranexamic acid (TXA) has shown significant reductions in blood loss and transfusion rates in total knee arthroplasty (TKA). However, the optimal administration route continues to be debated. The aim of this trial was to compare the effectiveness of intravenous (IV) versus peri-articular injection (PAI) application of tranexamic acid in patients undergoing total knee arthroplasty.MethodsWe conducted a randomized controlled, double-blinded study. A total of 93 patients undergoing primary unilateral TKA were randomly distributed between 2 groups: the IV group (47 cases; 1 g TXA IV) and the PAI group (46 cases; 1 g TXA injected peri-articularly). The amount of total and hidden blood loss (HBL), drainage, transfusion rate, hemoglobin and hematocrit drift, and complications were recorded.ResultsPeri-articular injection of TXA reduced total blood loss (P < 0.001) and HBL more than IV use of TXA (P < 0.001). No patients in either group received a transfusion. No symptomatic deep venous thrombosis or other severe complications occurred.ConclusionPeri-articular injection of TXA significantly reduced total blood loss and hidden blood loss to a greater degree than IV injection in total knee arthroplasty without reduction of drainage volume.Trial registrationChinese Clinical Trial Registry, ChiCTR-INR-16010270. Date of registration: December 27, 2016.
Highlights
Tranexamic acid (TXA) has shown significant reductions in blood loss and transfusion rates in total knee arthroplasty (TKA)
Total knee arthroplasty (TKA) can result in an estimated 800 to 1200 ml of blood loss, which has traditionally resulted in a transfusion rate as high as 53% [1,2,3]
TXA is a competitive inhibitor of plasminogen activation that interferes with fibrinolysis improving hemostasis and helping prevent additional blood loss after tourniquet deflation during TKA [9]
Summary
Tranexamic acid (TXA) has shown significant reductions in blood loss and transfusion rates in total knee arthroplasty (TKA). TXA is a competitive inhibitor of plasminogen activation that interferes with fibrinolysis improving hemostasis and helping prevent additional blood loss after tourniquet deflation during TKA [9]. This prothrombotic effect has raised concern about the risk of thromboembolic complications in total joint arthroplasty. This concern has led to the investigation of topical and local administration of TXA during TKA procedures with continued effectiveness in reducing blood loss and transfusion rates [10]
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