Intra-articular versus Intravenous Tranexamic Acid in Total Knee Arthroplasty: A Randomized Clinical Trial

Abstract

Background: Total knee arthroplasty (TKA) can cause excessive blood loss requiring allogenic transfusions.<br />Tranexamic acid (TXA) has been increasingly used for lowering blood loss. The present study aimed to compare<br />the efficacy of intravenous (IV) and intra-articular (IA) administrations of TXA in TKA patients who receive aspirin as<br />chemoprophylaxis and uses no drain post-operative.<br />Methods: In this prospective randomized clinical trial, 49 TKA patients were intravenously given 15 mg/kg dose of<br />TXA, and 49 patients intraarticularly received 15 mg/kg of TXA. Demographic information, pre-operative and postoperative<br />hemoglobin values of the patients were used for assessing total perioperative blood loss by GOOD &<br />NADLER formulae.<br />Results: There was not any significant difference between the IV TXA and IA TXA groups concerning blood loss<br />(P=0.102). However, the decrease in hemoglobin level at 48 hours post-operation compared to the preoperative<br />level in the IV TXA group was significantly higher than that in the IA TXA group (-2.3 ±0.8 vs. -1.9 ±1.0 g/dL;<br />P=0.038). No blood transfusion was needed, and the deep venous thrombosis and pulmonary embolization were<br />not observed in either of the groups (P>0.05).<br />Conclusion: Our study showed that during TKA, the IA TXA is equally safe and effective as its IV infusion concerning<br />decreased blood loss and adverse effects. The use of TXA during TKA is safe for patients who receive less potent<br />chemoprophylaxis agents such as aspirin.<br />Level of evidence: I