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 a challenge. It has been demonstrated that Tranexamic acid (TXA) can help reduce perioperative blood loss. TXA can be used via oral, topical or intravenous routs. The current study aimed to compare the effectiveness of intravenous versus topical use of TXA in reducing perioperative blood loss after primary total knee arthroplasty. Methods: Eighty-five patients who were candidates for total knee arthroplasty were randomized into two groups: one group received intravenous (IV) TXA, 15mg/kg, 10 min before tourniquet inflation while the other group received intraarticular (topical) TXA, 1 g diluted in 10 cc saline, during wound closure. The postoperative blood loss was estimated by measuring the whole drain output and also hemoglobin (Hb) drops. Moreover, we secondarily assessed and compared the need for allogenic blood transfusion and thromboembolic events. Results: Out of 387 thoracic screws and 373 lumbar screws, 65 (16.8) and 34 (9.1) screws perforated the pedicle wall or vePatients who received topical TXA had a higher total drain output ( 315 cc versus 226 cc; P< 0.001) compared to the IV route. The hemoglobin drop also was greater in the topical group although it was marginally significant (1.5 mg/dl versus 1.1 mg/dl; P= 0.05). No patient required further blood transfusion nor was diagnosed with a thromboembolic event. Conclusion: IV TXA seems more effective in reducing postoperative blood loss after primary TKA compared to the topical route.