Topical Intra-Articular Compared with Intravenous Tranexamic Acid to Reduce Blood Loss in Primary Total Knee Replacement

Abstract

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

“…In the published literature the timing of exactly when these doses are administered varies and in several studies is not explicitly explained [8][9][10][11][12][13][14][15][16][17][18][19]. The most commonly cited doses for topical TXA are 1.5-3 grams for joint irrigation and 0.5-2 grams for intra-articular injection typically administered following tourniquet let down or immediately before closure [14,17,[20][21][22][23][24][25][26][27]. Investigations using these dosing strategies almost universally observe significant decreases in total blood loss, total hemoglobin reduction, and transfusion rates.…”

The Inflammatory Reflex and Neural Tourniquet: Harnessing the Healing Power of the Vagus Nerve

“…In the overwhelming majority of cases, patients do not receive prophylactic medications to reduce the incidence of bleeding. One notable exception is with joint replacement procedures, where administration of tranexamic acid has been shown to reduce bleeding severity [39,40]. Moreover, individuals who have acquired coagulopathies or other bleeding diatheses secondary to medications may receive treatment as well.…”

Topical versus intravenous tranexamic acid in total knee arthroplasty

“…[14][15][16][17] However, its route of administration is still a matter of debate. [18][19][20][21][22][23][24][25] Intravenous (IV) route of administration can lead to various systemic complications such as deep vein thrombosis (DVT)/pulmonary embolism (PE). [26][27][28][29] Topical application of TXA has been proposed to decrease these adverse effects.…”