Efficacy of intravenous versus topical administration of tranexanmic acid in primary total knee arthroplasty

Hu Wen-hao

doi:10.3969/j.issn.2095-4344.0030

Abstract：BACKGROUND: Blood loss is a significant concern for patients undergoing total knee arthroplasty (TKA). Increasing evidence has shown that tranexamic acid is effective in decreasing perioperative blood loss in TKA. OBJECTIVE: To compare the efficacy of two methods of tranexanmic acid administration on the perioperative blood loss in primary TKA. METHODS: Totally 105 patients with unilateral knee osteoarthritis undergoing TKA were randomly allocated to three groups: 1 g of tranexanmic acid was administered intravenously before and after wound closure (group A); 2 g of tranexanmic acid in 20 mL of normal saline was injected into the articualr cavity through the drainage after wound closure and the tube was clamped for 4 hours (group B); no tranexanmic acid administration (group C). The intraoperative blood loss, hemoglobin level at postoperative 24 and 48 hours, postoperative drainage volume and incidence of deep venous thrombosis were recorded. RESULTS AND CONCLUSION: (1) The intraoperative blood loss and postoperative drainage volume in the groups A and B were significantly less than those in the group C (P < 0.05); the postoperative hemoglobin level in the group A was higher than that in the group B; the postoperative drainage volume in the group B was less than that in the group A; the total blood loss in the group A was significantly less than that in the group B (P < 0.05). (2) None patient appeared with lower limb deep venous thrombosis. (3) These findings indicate that intravenous and topical administration of tranexamic acid can significantly reduce the perioperative blood loss in primary TKA, and cannot increase the risk of thrombosis.