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

Blood loss during and immediately after total knee arthroplasty (TKA) is among the most challengingconcerns. It has been demonstrated that Tranexamic acid (TXA) can help to reduce perioperative blood loss. TXAcan be used as an oral, topical or intravenous injection. Many studies evaluated the effectiveness of each route ofadministration but few works on a comparison between them. The current study aimed to compare the effectivenessof intravenous injection versus topical use of TXA in reducing perioperative blood loss after primary total kneearthroplasty.

Eighty-five patients who were a candidate for total knee arthroplasty were randomized into two groups:one group received Intravenous injection of 15 mg/kg TXA, 10 min before tourniquet inflation while the other groupreceived 1 g diluted TXA during wound closure. The postoperative blood loss was estimated by measuring thewhole drain output and also hemoglobin (HB) drops. Both groups compared based on the need for allogenic bloodtransfusion and also thromboembolic events.

Patients who received topical TXA had a higher total drain output (P<0.0001) compared to intravenousinjection. The hemoglobin drop also was more in the topical group although it was marginally significant (P=0.05).

Intravenous injection of TXA is more effective in reducing postoperative blood loss after primary TKAcompared to topical administration.Level of evidence: I