Effect of Topical and Intravenously Applied Tranexamic Acid Compared to Control Group on Bleeding in Primary Unilateral Total Knee Arthroplasty

Abstract

We aimed to answer the following three questions in this study: (1) Does tranexamic acid (TA) reduce the amount of bleeding in total knee arthroplasty (TKA)? (2) Does TA reduce requirement for blood transfusion? (3) Is there any difference on reliability and efficacy between topical and intravenous (IV) applications of TA? Patients were allocated into three groups randomly by a software program as topical, IV, and control group. TA was applied as 20 mg/kg to the IV group and as 3 g/100 mL saline to the topical group. The hemoglobin values were recorded preoperatively and postoperatively on the same day and on day 1 and day 2. Removal of the drain postoperatively and length of hospital stay, as well as any complications such as pulmonary embolism or deep venous thrombosis, were also noted. The study comprised 40 patients in the IV group, 42 in the topical group, and 41 in the control group. The drain output values were similar in the IV and topical groups ( = 0.161), while those of the control group were significantly higher than both the IV and topical groups ( < 0.001 and < 0.001). Transfusion was applied to 19.5% of cases in the control group, 4.8% in the topical group, and 5.1% of the IV group ( = 6.522; = 0.038). The results of the study showed that 20 mg/kg single-dose IV bolus or 3 g topical TA application reduced blood loss and transfusion requirement without increasing the rate of thromboembolic complications in unilateral primary TKA.

Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

“…Four trials 16,32,35,39 were found to have a low risk of bias and 11 trials 17,31,33,34,[36][37][38][40][41][42][43] were found to have a high risk of bias (►Fig. 2).…”

“…Adequate randomized sequence was generated in 14 trials, 16,17,[31][32][33][34][35][36][37][38][39][41][42][43] and appropriate allocation concealment was reported in 12 trials. 16,17,31,32,34,35,[37][38][39][41][42][43] Blinding of participants and outcome assessors was clear only in four trials. 16,32,35,39…”

“…A total of 15 trials 16,17,[31][32][33][34][35][36][37][38][39][40][41][42][43] provided direct comparison of topical and intravenous TXA on blood transfusion rate. The pooled analysis for transfusion rate showed no statistically significant difference in the topical group compared with the intravenous group (RD ¼ 0.00, 95% CI ¼ À 0.02 to 0.03, p ¼ 0.75, ►Fig.…”

“…Nine trials 16,17,[31][32][33][34]37,38,41 provided relevant data on maximum Hb drop. The pooled analysis showed no statistically significant difference in the topical group compared with the intravenous group (MD ¼ 0.20 g/dL, 95% CI ¼ À 0.14 to 0.54 g/dL, p ¼ 0.24).…”

Preoperative FIBTEM Predicts Postoperative Hemorrhage in Total Knee Arthroplasty

“…17 There are evidences for use of intravenous or topical tranexamic acid to reduce perioperative blood loss and transfusion in major orthopedic surgery. 26,27 Tranexamic acid also attenuated fibrinolysis aggravated by colloid. 28 Fourth, FIB-TEM values are higher in patients with a lower (<36%) hematocrit than in patients with higher hematocrit values.…”