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

Authors

  • Ali Torkaman Department of Knee Surgery, Firouzgar Hospital, Iran University of Medical Sciences,Tehran , Iran
  • Amir Rostami Bone and Joint Reconstruction Research Center, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
  • Hamidreza Yazdi Bone and Joint Reconstruction Research Center, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
  • Hossein Akbari Aghdam Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences , Isfahan, Iran - Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
  • Mohammad Reza Sarshar Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Abstract:

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

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Journal title

volume 8  issue 3

pages  363- 367

publication date 2020-05-01

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