Comparative study of topical vs. intravenous tranexamic acid regarding blood loss in total knee arthroplasty

Abstract

ObjectiveTo compare topical vs. intravenous tranexamic acid (TA) in total knee arthroplasty regarding blood loss and transfusion.MethodsNinety patients were randomized to receive TA intravenously (20 mg/kg in 100 mL of saline; group IV), topically (1.5 g in 50 mL of saline, sprayed over the operated site, before release of the tourniquet; topical group), or intravenous saline (100 mL with anesthesia; control group). The volume of drained blood in 48 h, the amount of transfused blood, and the serum levels of hemoglobin and hematocrit before and after surgery were evaluated.ResultsThe groups were similar for gender, age, weight, laterality, and preoperative hemoglobin and hematocrit levels (p > 0.2). The hemoglobin level dropped in all groups when comparing the preoperative and the 48-h evaluations: the control group decreased 3.8 mg/dL on average, while the IV group had a decrease of 3.0, and the topical group, of 3.2 (p = 0.019). The difference between the control and IV groups was confirmed by Bonferroni test (p = 0.020). The difference between the control group and the topical group was not significant (p = 0.130), although there was less reduction in hemoglobin in the topical group; the comparison between the IV group and the topical group was also not significant (p = 1.000).ConclusionUsing topic and IV tranexamic acid decreased blood loss and the need for transfusion in total knee arthroplasty. Topical application showed results similar to IV use regarding the need for blood transfusion, but without the possible side effects of IV administration.

Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

“…Gianakos et al [12] published the latest meta-analysis on IA vs. IV in 2018, and it demonstrated the superiority of IA over IV administration. However, with the publication of 14 new randomized controlled trial (RCT) results thereafter [13][14][15][16][17][18][19][20][21][22][23][24][25][26], it is imperative to perform a new meta-analysis to corroborate or repudiate the conclusion of Gianakos et al, which is the purpose of our study.…”

Prospective, randomised, controlled study on the efficacy and safety of different strategies of tranexamic acid with total blood loss, blood transfusion rate and thrombogenic biomarkers in total knee arthroplasty: study protocol

“…TXA, an antifibrinolytic agent, has received increasing attention; it is shown to have effectively reduced blood loss following TKA. While previous studies have compared TXA administrations between intravenous usage and one or two of three topical usages, [27][28][29][30][31][32] and there is no consensus or best practices regarding route of TXA in knee arthroplasty. Therefore, we designed this study to compare the efficacy of different strategies of TXA (comparison of intravenous and topical applications and comparison of three topical applications).…”

Comparison of Hemostasis With Tranexamic Acid in Total Knee Arthroplasty

“…Therefore, the use of pharmacological strategies aimed at reducing bleeding, especially after the release of ischemia, has been both gaining adherents and being the target of several studies. Among these strategies, the use of TXA 2 ),( 8 ),( 13 ),( 18 ) draws attention.…”