The Efficacy of Intravenous Versus Topical Use of Tranexamic Acid in Reducing Blood Loss after Primary Total Knee Arthroplasty: A Randomized Clinical Trial

Abstract

Background: Blood loss during and immediately after total knee arthroplasty (TKA) is among the most challenging<br />concerns. It has been demonstrated that Tranexamic acid (TXA) can help to reduce perioperative blood loss. TXA<br />can be used as an oral, topical or intravenous injection. Many studies evaluated the effectiveness of each route of<br />administration but few works on a comparison between them. The current study aimed to compare the effectiveness<br />of intravenous injection versus topical use of TXA in reducing perioperative blood loss after primary total knee<br />arthroplasty.<br />Methods: Eighty-five patients who were a candidate for total knee arthroplasty were randomized into two groups:<br />one group received Intravenous injection of 15 mg/kg TXA, 10 min before tourniquet inflation while the other group<br />received 1 g diluted TXA during wound closure. The postoperative blood loss was estimated by measuring the<br />whole drain output and also hemoglobin (HB) drops. Both groups compared based on the need for allogenic blood<br />transfusion and also thromboembolic events.<br />Results: Patients who received topical TXA had a higher total drain output (P<0.0001) compared to intravenous<br />injection. The hemoglobin drop also was more in the topical group although it was marginally significant (P=0.05).<br />Conclusion: Intravenous injection of TXA is more effective in reducing postoperative blood loss after primary TKA<br />compared to topical administration.<br />Level of evidence: I