Acid In Total Knee Arthroplasty Research Articles

Application of Tranexamic Acid in Total Knee Arthroplasty - Prospective Randomized Trial.

Background:The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has shown good results. Bleeding may cause local complications consequently greater pain and reduced function postoperatively. No study has related the use of TXA to these facts.Objective:The aim was to evaluate the effects of TXA haemoglobin, Western Ontario and McMaster Universities Index (WOMAC), pain intensity and flexion gain after TKA.Methods:43 patients were randomized and then underwent TKA. TXA was applied to 22 of these patients before closure of the joint capsule. Haemoglobin measurements (mg/dL) were taken preoperatively and 24 and 48 hours after surgery. The WOMAC questionnaire and pain visual analogue scale (VAS) were applied, and flexion gain was measured up to the second postoperative month. Statistical analysis compared the results to determine whether there were differences between the groups for each of the evaluated times.Results:There were differences in favour of the drug 48 hours postoperatively for the haemoglobin variable (p = 0.01), in pain evaluation, 24 and 48 hours, postoperatively (p < 0.01) and in flexion gain, 24 hours after surgery (p = 0.03). There were no significant differences between the groups in the haemoglobin evaluation 24 hours postoperatively, in pain assessment 7 days, 21 days and 2 months, postoperatively, in flexion gain 48 hours, 7 days, 21 days and 2 months, postoperatively and in WOMAC after 2 months.Conclusion:In addition to reducing bleeding, topical TXA improved pain and increased flexion gain in the first hours after TKA.Trial Registration:RBR-9b4qgq

Intra-articular Application is More Effective Than Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

BackgroundThe optimal administration route of tranexamic acid (TXA) in total knee arthroplasty (TKA), and the effect of TXA on hidden blood loss and total blood loss are undetermined. The purpose of this study was to compare the effectiveness of intravenous versus intra-articular application of tranexamic acid in patients undergoing knee arthroplasty. MethodsA total of 150 patients undergoing primary unilateral total knee arthroplasty were randomly distributed to 3 groups (IV, intra-articular, and control group; each 50 patients) and administrated TXA (1 g IV and 50 mL intra-articular saline, 1 g intra-articularly and 50 mL intra-articular saline, and 0 g and 50 mL intra-articular saline, respectively). The amount of total and hidden blood loss (HBL), drainage, transfusion, changes in hemoglobin levels, and complications were recorded. ResultsIntra-articular use of TXA reduced more total blood loss (P = .011) and reduced more total 48 hours drainage volume than IV use of TXA (P < .001). Two patients received transfusion in IV and control group. No deep venous thrombosis or other severe complications had occurred. The HBL volume had no significant difference among the control, IV, and intra-articular groups (708.6 ± 308.2, 651.7 ± 302.9, and 625.2 ± 252.1 mL, respectively; which was 65.6%, 70.8%, and 81.1% of the total loss). ConclusionIntra-articular administration of TXA significantly reduced total blood loss and drainage volume to a greater degree than IV injection in total knee arthroplasty without reduction of HBL.

Tranexamsäure bei Knieendoprothetik: intraartikuläre und i. v. Gabe gleichwertig!

Goyal N et al. Intravenous vs. Intra-articular tranexamic acid in total knee arthroplasty: a randomized, double-blind trial. J Arthroplasty 2017; 32: 28 – 32

Is combined use of intravenous and intraarticular tranexamic acid superior to intravenous or intraarticular tranexamic acid alone in total knee arthroplasty? A meta-analysis of randomized controlled trials

BackgroundTranexamic acid (TXA) has been proven to be effective in reducing blood loss and transfusion rate after total knee arthroplasty (TKA) without increasing the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Recently, an increasing number of studies have been interested in applying combined intravenous (IV) with intraarticular (IA) tranexamic acid in total knee arthroplasty. The purpose of this meta-analysis was to compare the blood loss and complications of combined TXA with IV TXA or IA TXA on TKA.MethodsSystematic search of literatures were conducted to identify related articles that were published in PubMed, MEDLINE, Embase, the Cochrane Library, SpringerLink, ClinicalTrials.gov, and Ovid from their inception to September 2016. All studies that compare blood loss and complications of combined TXA and IV TXA or IA TXA on TKA were included. Main outcomes were collected and analyzed by the Review Manager 5.3.ResultsFive studies were included in the present meta-analysis. There was significant difference in total blood loss and blood volume of drainage when compared combined TXA group with IV TXA group or IA TXA group (P < 0.05). There was no difference in transfusion rate and thromboembolic complications when comparing combined TXA with IV TXA or IA TXA alone (P > 0.05).ConclusionsCompared with administration of IA TXA or IV TXA alone on TKA, combined use of TXA has advantages in reducing total blood loss and blood volume of drainage without increasing the incidence of thromboembolic complications. We recommend combined TXA as the preferred option for patients undergoing TKA.

Comparison of intra-articular versus intravenous application of tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials.

IntroductionThere is much controversy about the optimal application of tranexamic acid (TXA) in total knee arthroplasty (TKA). The purpose of this meta-analysis was to compare the efficacy of the intra-articular and intravenous regimens of TXA in TKA.Material and methodsA literature search of the PubMed, Embase and Cochrane Library databases was performed. Randomized controlled trials comparing the result of intra-articular and intravenous application of TXA during TKA were included. The focus was on the outcomes of blood loss, transfusion requirement and thromboembolic complications.ResultsSix studies were eligible for data extraction and meta-analysis. We found no statistically significant difference between intra-articular and intravenous administration of tranexamic acid in terms of total blood loss (WMD, 6.01; 95% CI: –96.78 to 108.79; p = 0.91), drain output (WMD = –20.26; 95% CI: –51.34 to 10.82; p = 0.20), hemoglobin drop (WMD = 0.33; 95% CI: –0.31 to 0.98; p = 0.31), or the incidences of transfusion (RR = 0.98; 95% CI: 0.56–1.70; p = 0.93) as well as deep vein thrombosis (RR = 0.49; 95% CI: 0.09–2.73; p = 0.42).ConclusionsIn comparison with intravenous application of TXA, intra-articular application had a comparable effect on reducing blood loss and the transfusion rate without increasing the complication rate.

Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials.

Tranexamic acid (TXA) is an antifibrinolytic drug used widely to prevent bleeding in total knee arthroplasty (TKA). However, there is no consensus regarding the administration routes of TXA. This meta-analysis aimed to investigate the efficacy of topical (intra-articular) versus intravenous TXA in reducing blood loss and transfusion rate in patients who underwent TKA. We conducted a Pubmed, EMBASE, Cochrane Library, and Web of Science search for randomized controlled trials (RCTs) comparing topical versus intravenous TXA in TKA. Two authors conducted selection of studies, data extraction, and assessment of risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software. Sixteen RCTs with a total of 1330 patients were included. Current meta-analysis indicated that there were no significant differences in total blood loss (MD = -41.64ml; 95% CI: -163.43ml to 80.18ml; P = 0.50), drain output (MD = 22.44, 95% CI: -11.18 to 56.06, P = 0.19), transfusion rate (RR = 0.89, 95% CI: 0.62 to 1.27, P = 0.52), the drop of Hb level at post-operative day 1 (MD = 0.26, 95% CI -0.03 to 0.55, P = 0.03), day 2 (MD = -0.08, 95% CI -0.76 to 0.59, P = 0.81), day 3 (MD = -0.20, 95% CI -0.77 to 0.37, P = 0.49), and length of stay (MD = -0.10; 95% CI: -0.17 to -0.02; P = 0.02) between the topical group and intravenous group. In addition, no significant differences were found regarding the incidence of adverse effects such as deep venous thrombosis (RR = 1.08, 95% CI: 0.48 to 2.40, P = 0.86), pulmonary embolism (RR = 0.56, 95% CI: 0.05 to 5.99, P = 0.63), wound complications (RR = 0.56, 95% CI: 0.05 to 5.99, P = 0.63), and infection (RR = 0.74, 95% CI: 0.30 to 1.85, P = 0.52) between the two groups. Our meta-analysis of 16 RCTs revealed that both topical TXA and intravenous TXA are effective in reducing blood loss and transfusion rates in patients who underwent TKA.

Use of tranexamic acid in total knee arthroplasty.

different strategies have been developed to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. we enrolled all patients submitted to a primary TKA in our department between November 2014 and August 2015. They were divided into three groups corresponding to the method of TXA administration used: intravenous (IV), intra-articular (IA), and a combination of the two. Demographic data, as well as preoperative hemoglobin and platelet levels, were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions; postoperative pain was also assessed. Student's t-test or a χ2 test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences. the sample comprised 34 patients: IV, 10 cases; IA, 15 cases, and combined (IV + IA), 9 cases. The average age of the patients was 71.1±6.4 years. No significant differences in the outcome measures were found between the groups, with the exception of a significantly lower maximum hemoglobin loss in the combined versus the IV group (p=0.02). There were no differences between the groups in the amount of blood in the drain or the rate of transfusions. the data from this preliminary study, as well as data from the literature, confirm that TXA administration is safe and effective in reducing total blood loss in TKA, and no administration protocol seems to be superior to the others. Level II, prospective comparative study.

Intravenous vs Topical Tranexamic Acid in Total Knee Arthroplasty Without Tourniquet Application: A Randomized Controlled Study

BackgroundUse of tranexamic acid (TXA) is effective and safe in reducing the blood loss in total knee arthroplasty (TKR) performed using a tourniquet, but, data in TKR performed without tourniquet are limited, and there is no study comparing the topical (T) with intravenous (IV) TXA administration. Our aim was to compare the topical (T) with intravenous (IV) TXA administration in TKR performed without tourniquet. Material and methodsA total of 120 patients undergoing unilateral TKR for knee osteoarthritis were included in a prospective randomized study. Operations were performed under spinal anesthesia, no tourniquet was used, and the postoperative regime was the same for all patients. Patients were divided into 3 groups; in group C (control), 40 patients received no TXA, in group IV, 40 patients received 1 g of TXA intravenously, and in group L, 1 g of TXA was applied locally to 40 patients. The primary outcome measures included the calculated blood loss, the transfusion rate, and quantity of allogeneic blood units, whereas secondary outcome measures were complications. ResultsThere was no statistically significant difference in patient's demographics and perioperative results. Calculated blood loss, allogeneic blood transfusion rate, and quantity in group C were significantly higher compared with those of TXA groups (P < .001). There was no significant difference in complications rate between the 3 groups. ConclusionsAccording to the results of this study, IV or T administration of 1-g TXA significantly reduced the blood loss and the need for allogeneic blood transfusion in patients undergoing TKR without a tourniquet (with no significant difference between the 2 routes of administration).

Effect of the Drained-clamped Method with Intra-articular Infusion of Tranexamic Acid in Total Knee Arthroplasty – A Randomized Prospective Study

Effect of the Drained-clamped Method with Intra-articular Infusion of Tranexamic Acid in Total Knee Arthroplasty – A Randomized Prospective Study

Commentary: Clinical and Financial Benefits of Intra-Articular Tranexamic Acid in Total Knee Arthroplasty

means to treat end-stage knee arthritis. The annual number of TKAs has been increasing worldwide. Various means have been used to reduce blood loss and the incidence of blood transfusion during TKA.1,2 In TKA patients, the predictors of the need for blood transfusion are preoperative haemoglobin level, intra-operative blood loss, and post-operative drain output.3 The use of tranexamic acid has gained popularity, partly attributable to the advocacy of fast track surgery. In this issue, Goyal et al.4 compared the early clinical outcome in patients who underwent primary TKA with the use of intra-articular TXA. The authors reported a lower transfusion rate and shorter hospital stay in the TXA than control group. The total cost saving with regard to the reduced blood transfusion was AU$144 per patient. Combined with the shortened hospital stay, the total saving was AU$631 Commentary: Clinical and financial benefits of intra-articular tranexamic acid in total knee arthroplasty

Clinical and financial benefits of intra-articular tranexamic acid in total knee arthroplasty.

To determine whether intra-articular tranexamic acid (TXA) use after total knee arthroplasty (TKA) results in decreased postoperative blood transfusion and length of hospital stay. Medical records of 1981 patients (mean age, 69.2 years) who underwent primary TKA with (n=1006) or without (n=975) TXA use by any of 4 knee arthroplasty surgeons were reviewed. TXA (3000 mg/30ml) was administered via an epidural catheter into the knee joint after wound closure. Postoperative blood transfusion was given to patients with haemoglobin (Hb) level <80 g/dl on days 1 and 2 or with symptoms of acute anaemia. Intra-articular TXA use after TKA resulted in a lower blood transfusion rate (4.5% [45/1006] vs. 14.8% [144/975], p<0.0001), fewer units of blood transfused (86 vs. 313 units, p<0.0001), fewer units of blood transfused per 100 patients (8.5 vs. 32.1, p<0.0001), and shorter length of hospital stay (4.7±2.3 vs. 5.3±2.7 days, p<0.0001). Total cost savings with respect to the reduction in blood transfusion was AU$143.68 per patient. When the change in length of hospital stay and TXA costs were included, the overall saving was AU$631.36 per patient. Intra-articular TXA use can reduce costs as a result of decreased blood transfusion rate and length of hospital stay in patients undergoing TKA.

The James A. Rand Young Investigator's Award: A Randomized Controlled Trial of Oral and Intravenous Tranexamic Acid in Total Knee Arthroplasty: The Same Efficacy at Lower Cost?

BackgroundTranexamic acid (TXA) is a synthetic antifibrinolytic agent successfully used intravenously (IV) to reduce blood loss after total knee arthroplasty (TKA). An oral formulation of the medication is available, at a fraction of the cost of the IV preparation. The purpose of this randomized controlled trial is to determine if oral TXA is equivalent to IV TXA in reducing blood loss in TKA. MethodsIn this double-blinded, placebo-controlled trial, patients undergoing primary TKA were randomized to receive 1.95g of TXA orally 2 hours preoperatively or 1g IV bolus before wound closure. The primary outcome was reduction of hemoglobin. Power analysis determined that 30 patients were required in each group. Equivalence analysis was performed with pooled and Satterthwaite t tests with a P-value of <.05 suggesting equivalence between treatments. ResultsThirty-four patients received oral TXA and 37 patients received IV TXA. There was no difference in the mean reduction of hemoglobin between oral and IV groups (3.45g/dL vs 3.31g/dL, respectively; P = .001, equivalence), and total blood loss was equivalent at 1281 mL vs 1231 mL, respectively (P = .02, equivalence). One patient in each group was transfused. ConclusionOral TXA provides equivalent reductions in blood loss, at a cost of $14 compared with $47-$108 depending on the IV formulation selected. As approximately 700,000 primary TKA are performed in the United States annually, a switch to oral TXA could yield total cost savings of between $23 million and $67 million dollars per year for our health care system.

Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial

BackgroundDespite the proven efficacy of both intravenous (IV) and intra-articular (IA) tranexamic acid (TXA) in reducing blood loss during total knee arthroplasty (TKA), the ideal route of administration remained debatable. This study aimed to compare the effect of IV versus IA TXA on transfusion incidences, perioperative blood loss and postoperative lower limb swelling during TKA. MethodsOne hundred patients were prospectively randomised into two groups: 1) IV TXA; and 2) IA TXA. In both groups, TXA was administered intraoperatively after cementing the prostheses. The perioperative blood loss was calculated using the haemoglobin balance method. The thigh, suprapatellar, and calf girths were measured preoperatively and on postoperative day (POD) 4. ResultsTwo patients in the IV group and one patient in the IA group required blood transfusion (p=0.500). The median and interquartile range (IQR) of perioperative blood loss on POD1 and POD4 was 530 (IQR 386,704) and 730 (IQR 523,925) ml for the IV group, compared with 613 (IQR 506,703) and 799 (IQR 563,1067) ml for the IA group (p=0.090 and p=0.232 respectively). The median increment in thigh, suprapatellar, and calf girths were 1.5 (IQR 0, 3.0), 2.0 (IQR 0.5, 4.0) and 0 (IQR 0, 1.0) cm for the IV group, compared to 2.0 (IQR 1.0, 4.0), 2.0 (IQR 0, 4.5) and 0 (IQR 0, 1.5) cm for the IA group (p=0.246, p=0.562, and p=0.937 respectively). ConclusionsBoth IV and IA TXA had comparable effect on transfusion incidences, perioperative blood loss, and postoperative lower limb swelling during TKA. IA TXA is an alternative to IV TXA.Level of evidence: I.

Use of intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials

ObjectiveThe effect of tranexamic acid (TA) on patients receiving total knee arthroplasty (TKA) has been reported in many small clinical trials. But single trials are not sufficient enough to clarify the effectiveness and safety of TA. So, we carried out a meta-analysis of randomized controlled trials to investigate the efficacy and safety of the intravenous use of TA in TKA. MethodsLiteratures were retrieved in Cochrane Library, OVID, PubMed, EMBASE, CNKI and Wanfang Data. All the related literatures were checked by two independent investigators and only the high quality randomized controlled trials were enrolled. Relevant data were analyzed using RevMan 5.1 to compare the difference of blood loss, transfusion and complications between TA group and control group. ResultsThere were 353 related literatures and only 22 randomized controlled trials met the inclusion criteria. The use of TA in TKA significantly reduced total blood loss by a mean of 435.41ml (95% CI 300.62-570.21, P<0.01), postoperative blood loss by a mean of 406.69ml (95% CI 333.16480.22, P<0.01). TA also significantly lowered the transfusion rate (risk difference 0.30, 95% CI 0.21-0.39, P<0.01) and transfusion volume (mean difference 0.95 unit, 95% CI 0.531.37, P<0.01). The risks between TA group and control group in developing deep vein thrombosis and pulmonary embolism were not statistically significant. ConclusionTA is beneficial for patients undergoing TKA, which can significantly reduce total blood loss, postoperative blood loss, transfusion rate, and transfusion volume. Meanwhile TA is recommended to reduce deep vein thrombosis and pulmonary embolism following TKA.

Combined Administration of Systemic and Topical Tranexamic Acid for Total Knee Arthroplasty: Can It Be a Better Regimen and Yet Safe? A Randomized Controlled Trial

BackgroundTotal knee arthroplasty (TKA) is associated with substantial blood loss in postoperative period. Tranexamic acid (TXA) is potent antifibrinolytic agent, routinely administered by intravenous (IV) and topical route, which can possibly interrupt cascade of events due to hemostatic irregularities close to source of bleeding. However, scientific evidence of combined administration of TXA in TKA is still meagre. The present study aimed to compare efficacy of combined IV and topical TXA with IV use alone in terms of blood loss, transfusion rate, and incidence of deep vein thrombosis and thromboembolism. Patients and Methods119 patients undergoing unilateral TKA were randomized into IV alone and combined group. Patients assigned to IV group were given IV TXA as a preoperative and postoperative dose given 3 and 6 hours after surgery, whereas in combined group, topical TXA solution was applied intraarticularly about 5 minutes before closure of arthrotomy in addition to IV doses. ResultsCombined use of IV and topical TXA provided better results than IV use alone with mean calculated total blood loss (590.69±191.1 vs 385.68±182.5, P<.001), blood transfusion rate (6.6% vs 1.6%, P = .364), hemoglobin drop (1.82±0.6 vs 1.14±0.5, P<.001). No case of DVT or TE was noted among the 2 study groups. ConclusionCombined use of IV and intraarticular TXA provided significantly better results compared with IV use alone with respect to all variables related to postoperative blood loss in TKA. Moreover, TXA use is safe in terms of incidence of symptomatic DVT and TE.

Efficacy of combined use of intraarticular and intravenous tranexamic acid in total knee arthroplasty.

Tranexamic acid (TXA) has come to light as an effective method to decrease blood loss and transfusion rates in total knee arthroplasty (TKA) without increasing the risk of thromboembolic events (TEE) (1). Many initial studies utilized intravenous (IV) TXA and more recently topical TXA has also been shown to be effective (2,3). In these studies, various dosing regimens have been used for both IV and topical TXA. Some have attempted to find the most beneficial regimen, demonstrating better results with two IV doses compared to a single IV dose (4,5). Others have compared various topical regimens to IV regimens, often comparing single topical doses to one or two IV doses (6-8). These have often shown similar results between IV and topical TXA; however, comparison is difficult due to variance in the regimens used (quantity of TXA, number of doses, route of topical administration). Our standard practice is to administer one gram IV prior to incision and one gram IV at initiation of closure. This provides an effective, easily reproducible routine for the entire surgical team.

Effectiveness and safety of tranexamic acid for total knee arthroplasty: a prospective randomized controlled trial.

BackgroundTotal knee arthroplasty (TKA) is associated with significant perioperative blood loss and need for transfusion. This study aimed to evaluate the effectiveness and safety of tranexamic acid (TXA) to reduce perioperative blood loss in patients receiving TKA.Material/MethodsA total of 92 patients who accepted unilateral TKA from May 2012 to May 2013 randomly received either 15 mg/kg TXA in 100 mL normal saline solution (TXA group, n=46) or the same amount of normal saline solution (placebo group, n=46) at 15 min before the tourniquet was loosened. The following data were recorded: intraoperative blood loss; post-operative drainage at 12 h; total drainage amount; hidden blood loss; total blood loss; transfusion volumes; number of transfusions; post-operative hemoglobin at 1, 3, and 5 days; D-dimer; number of lower limb ecchymoses; and deep vein thrombosis (DVT).ResultsA total of 81 patients were available for analysis (TXA group, n=41; placebo group, n=40). Post-operative12-h drainage, post-operative 24-h D-dimer values, total drainage volume, hidden blood loss, total blood loss, and the rate of postoperative ecchymosis were lower in the TXA group than in the placebo group (p<0.05). The post-operative 3-day Hgb was higher in the TXA group than in the placebo group (p=0.000). The rate of transfusion and DVT was similar in both groups (n.s.).ConclusionsPerioperative blood loss could be reduced after TKA by intravenously injecting 15 mg/kg TXA at 15 min before the tourniquet was loosened. The application of TXA is not associated with increased risk of DVT.

Safety and Efficacy of Tranexamic Acid in Total Knee Arthroplasty.

BackgroundThe prevalence of total knee arthroplasty (TKA) is increasing, which is one of the most frequent operations in orthopedic practice. To further investigate the safe and effective role of using tranexamic acid (TA) in reducing transfusion rate and blood loss in total knee arthroplasty.Material/MethodsThis meta-analysis was conducted according to the Cochrane methodology. Twenty-eight superior quality and well designed randomized controlled trials (RCT) were collected to analyze for this study. Patients who had undergone primary unilateral TKA were chosen. The software, RevMan 5.2, was used to analyze collected data.ResultsFinally, 28 RCTs were collected to analyze for this study. Total blood loss was dramatically decreased via the application of TA, by a mean of 420 ml [95% CI: −514 to −327]. A significant reduction about blood transfusion rate was also found in patients who received TA. [RD: −0.26, 95%CI: −0.33 to −0.19]. Moreover, no significant differences were found between TA and control groups in incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE).ConclusionsThis meta-analysis demonstrates that the application of TA in TKA could decrease total blood loss and transfusion rate. On the other hand, the application of TA is not associated with high incidence of DVT or other adverse events. TA should be taken into account in routine use in primary knee arthroplasty to benefit the patients.

Topical versus intravenous tranexamic acid in total knee arthroplasty

The objective of this study is to compare the effectiveness of intravenous versus topical application of tranexamic acid in patients undergoing knee arthroplasty. All patients who underwent primary knee arthroplasty at our total joint center over a 12-month period were included in the study. One surgeon utilized 1g of IV TXA at time of incision in all patients (n=373) except those with a documented history of venous thromboembolism (VTE). Two surgeons utilized a topical application of TXA for all patients without exception (n=198) in which the joint was injected after capsular closure with 3g TXA/100mL saline. The transfusion rate was 0% in the topical group vs. 2.4% in the IV group and this was statistically significant (P<0.05).

Safety and efficacy of intra-articular injection of tranexamic acid in total knee arthroplasty.

Tranexamic acid was intra-articularly injected in total knee arthroplasty (TKA) to reduce blood loss and transfusion. However, no single study has been large enough to definitively determine whether it is safe and effective. To determine the safety and efficacy of intra-articular tranexamic acid in TKA, the authors searched various databases for relevant randomized controlled trials. Mean difference (MD) in total blood loss, risk ratio (RR) for transfusion, and complication rate in the tranexamic acid-treated group vs the placebo group were calculated. Seven randomized controlled trials, including 622 patients (174 men and 448 women), were identified. All 7 placebo-controlled randomized trials had a low risk of bias. The pooled results showed a positive effect of tranexamic acid in all treatment groups, with significant reduction in total blood loss (MD, -396.42 mL [95% confidence interval (CI), -629.64 to -163.20]; P=.0009). However, there was significant heterogeneity in the finding (chi-square=27.16, df=3, I(2)=89%; P<.00001) among studies. The pooled results indicated that 5.8% (18 of 309) of tranexamic acid-treated patients required transfusion compared with 27.2% (85 of 313) of placebo-treated patients. This difference was significant (RR, 0.22; 95% CI, 0.14-0.35; P<.00001). There was no significant difference between the groups in the incidence of deep venous thrombosis (RR, 0.83; 95% CI, 0.35-1.98; P=.68) or pulmonary embolism (RR, 0.54; 95% CI, 0.10-2.85; P=.46). In all, intra-articular tranexamic acid significantly reduced total blood loss, drainage, reduction of hemoglobin, and the need for transfusion without increasing the incidence of deep venous thrombosis and pulmonary embolism. Intra-articular tranexamic acid is safe and efficacious in TKA.