Tranexamic acid in primary total knee arthroplasty without tourniquet: a randomized, controlled trial of oral versus intravenous versus topical administration

Abstract

Abundant literature confirms that intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) reduces blood loss in total knee arthroplasty (TKA). Oral formulations of TXA exhibit profound cost-saving benefits. However, comparisons of the clinical efficacy among three different modalities of TXA administration have not been previously investigated in the setting of TKA with no closed suction drain and tourniquet. A total of 180 patients undergoing TKA were randomized to receive 2-g oral TXA 2 hours preoperatively, 20-mg/kg IV TXA 5 minutes prior to incision, or 2-g IA TXA. The primary outcome was 72-hour blood loss. Secondary outcomes were reductions in hemoglobin, the rate of transfusions, and adverse events. No significant differences were identified with regard to the mean 72-hour blood loss among the three groups (1003 mL in oral group, 1108 mL in IV group, and 1059 mL in IA group, respectively). Similarly, hemoglobin reduction was equivalent among the groups. Only one patient in IV group exhibited deep venous thrombosis. No difference was identified regarding transfusion rates. Oral TXA results in similar blood loss in TKA, with a profound cost-saving benefit, compared with the IA and IV formulations.

Efficacy and safety of oral compared with intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a meta-analysis

“…The results of this study suggested that no significant differences were found in blood-sparing management between oral and IV TXA. This finding is comparable to the findings of a recent meta-analysis that shown that oral TXA provided equivalent blood-sparing efficacy when compared with intravenous routes [ 23 ].…”

“…Based on the criteria described in the methods, 14 articles were further eliminated by reading the full articles, but some did not provide enough detail of outcomes of two approaches. Therefore, a final total of 9 studies [ 11 , 16 – 23 ] with included (Fig. 1 ).…”

Comparison of oral versus intravenous tranexamic acid in total knee and hip arthroplasty

“…The Hb drop and total blood loss were the primary outcomes in our meta-analysis. Many studies [ 23 , 25 , 27 – 31 ] demonstrated that oral TXA provides similar reductions in Hb drop and total blood loss in primary THA and TKA compared with IV TXA. The results of this study found no significant differences in Hb drop and total blood loss between oral and IV TXA.…”

“…We conclude that compared with IV administration, the use of oral TXA has the same effects as IV TXA on the transfusion rate following THA and TKA. [ 31 , 32 ]…”

Finding the optimal control level of intraoperative blood pressure in no tourniquet primary total knee arthroplasty combine with tranexamic acid: a retrospective cohort study which supports the enhanced recovery strategy

“…Unlike other surgical procedures, there was no good way to control bleeding of the bone surface of the femur and tibia after osteotomy during TKA and this will cause trouble for non-tourniquet TKA. The use of tranexamic acid and control of the blood pressure during the operation are effective methods to reduce the bleeding of the surgical field [8][9][10]. The former studies showed that the use of tranexamic can not only reduce the total blood loss during the perioperative period but also reduce the intraoperative blood loss [11,12].…”