Intra-articular injection of tranexamic acid to reduce blood loss after total knee arthroplasty

Abstract

Purpose: To evaluate the effect of intra-articular tranexamic acid (TXA) on blood loss after total knee arthroplasty (TKA).

Methods: Medical records of 73 men and 93 women (mean age, 68 years) who underwent primary TKA for osteoarthritis and received intra-articular TXA 1500 mg (n=56) or 3000 mg (n=56) or not at all (n=54) were reviewed. Reduction in haemoglobin levels on days 1 and 2 was measured, as were the rates of venous thromboembolism (VTE) and blood transfusion.

Results: Reduction in haemoglobin levels on day 2 was significantly greater in controls (35 ± 11 g/dl) than the 1500 mg TXA group (29 ± 9 g/dl, p=0.005) and the 3000 mg TXA group (23 ± 10 g/dl, p<0.001). The difference between the 2 TXA groups was also significant (p=0.002). There was a dose-dependent effect of TXA on blood loss. The rates of VTE and blood transfusion did not differ significantly between groups.

Conclusion: Intra-articular administration of TXA is effective in reducing blood loss after TKA, without increasing the risk of VTE.

Keywords: arthroplasty, replacement, knee; hemorrhage; hemostasis; tranexamic acid.