Efficacy of Tranexamic Acid in Reducing Blood Loss in Total Knee Arthroplasty

Abstract

Objective:To evaluate the efficacy of tranexamic acid in reducing blood loss in total knee arthroplasty by examining the existing literature. Method:This literature review investigated the use of tranexamic acid in knee arthroplasty. The search was performed in the Pubmed, Science Direct, Google Scholar, and Lilacs databases over a 20-year period using the keywords: “knee arthroplasty, tranexamic acid, and efficacy”. Only randomized clinical trials published between 2000 and 2016 in English, Spanish, or Portuguese were accepted, and only trials which scored above 3 on the Jadad scale were selected. Results:A total of 7 randomized clinical trials met the inclusion criteria, with a sample of 948 patients. Conclusion:The use of tranexamic acid in total knee arthroplasty (unilateral or bilateral) reduces perioperative and postoperative blood loss more than other available antifibrinolytics. With this reduction in total blood loss and the need for blood transfusions without any increase in side effects, the use of tranexamic acid can be considered safe and effective in controlling bleeding after knee arthroplasties. Level of Evidence II; Systematic review.

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

“…Several studies have investigated the role of tranexamic acid in reducing blood loss and improving Hb in patients undergoing orthopedic surgeries like total knee replacement (TKR), total hip joint replacement (THR), and spine surgeries, but the definitive efficacy has not yet been documented. 15,16 Fibrinolysis is increased after surgical trauma, therefore increasing intraoperative and postoperative blood loss. Tranexamic acid inhibits fibrinolysis and thus decreases blood loss.…”

Efficacy of tranexemic acid in controlling perioperative blood loss in TKR patients using intravenous V/s intraarticular route

“…Allogenic transfusion of blood is also associated with complications apart from the cost involved [10] . So, a method to reduce the chances of blood loss and thus the need for an allogenic transfusion will benefit patients undergoing total knee arthroplasty Tranexamic acid (TXA), being inexpensive, effective and safe has become a popular choice for controlling blood loss in TKA [1] .TXA is a synthetic derivative of the amino acid lysine and binds the 5 lysine binding sites on plasminogen. This inhibits plasmin formation and displaces plasminogen from the fibrin surface.…”

“…Tranexamic acid (TXA), being inexpensive, effective and safe has become a popular choice for controlling blood loss in TKA. Though the effectiveness of TXA in controlling blood loss is widely demonstrated in various studies [1,2,3] , it's efficacy when given intra venous and intra articular in TKA is still debated 3 . There are only a few studies in the literature comparing the results of tranexamic acid given through different routes in our population [4,5,6] .…”

The efficacy and safety of combined administration of intravenous and intra‐articular tranexamic acid in total knee arthroplasty: An update meta‐analysis

“…Total knee arthroplasty (TKA) is one of the most commonly performed procedures to treat severe knee joint disease. However, TKA would initiate fibrinolysis system, which could lead to high blood loss (up to 2000 ml) 1–3 . Multiple blood conservation strategies have been used to control bleeding after TKA, including allogenic transfusion, preoperative autologous blood donation, and various blood salvage techniques 4,5 .…”