Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial
- 7 May 2015
- journal article
- research article
- Published by Springer Science and Business Media LLC in Archives of orthopaedic and trauma surgery
- Vol. 135 (7), 1017-1025
- https://doi.org/10.1007/s00402-015-2232-8
Abstract
Introduction Tranexamic acid (TXA) is becoming widely used in orthopedic surgery to reduce blood loss and transfusion requirements, but consensus is lacking regarding the optimal route and dose of administration. The aim of this study was to compare the efficacy and safety of topical and intravenous routes of TXA with routine hemostasis in patients undergoing primary total knee arthroplasty (TKA). Materials and methods We performed a randomized, multicenter, parallel, open-label clinical trial in adult patients undergoing primary TKA. Patients were divided into three groups of 50 patients each: Group 1 received 1 g topical TXA, Group 2 received 2 g intravenous TXA, and Group 3 (control group) had routine hemostasis. The primary outcome was total blood loss. Secondary outcomes were hidden blood loss, blood collected in drains, transfusion rate, number of blood units transfused, adverse events, and mortality. Results One hundred and fifty patients were included. Total blood loss was 1021.57 (481.09) mL in Group 1, 817.54 (324.82) mL in Group 2 and 1415.72 (595.11) mL in Group 3 (control group). Differences in total blood loss between the TXA groups and the control group were clinically and statistically significant (p < 0.001). In an exploratory analysis differences between the two TXA groups were not statistically significant (p = 0.073) Seventeen patients were transfused. Transfusion requirements were significantly higher in Group 3 (p = 0.005). No significant differences were found between groups regarding adverse events. Conclusion We found that 1 g of topical TXA and 2 g of intravenous TXA were both safe strategies and more effective than routine hemostasis to reduce blood loss and transfusion requirements after primary TKA. Level of evidence I.Keywords
Funding Information
- the Spanish Ministry of Health and Social Policy (EC10-73)
This publication has 30 references indexed in Scilit:
- Simultaneous Bilateral Computer Assisted Total Knee Arthroplasty: The Effect of Intravenous or Intraarticular Tranexamic AcidThe Journal of Arthroplasty, 2013
- Topical tranexamic acid in total knee replacement: A systematic review and meta-analysisThe Knee, 2013
- Management of severe perioperative bleedingEuropean Journal of Anaesthesiology, 2013
- Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic reviewKnee Surgery, Sports Traumatology, Arthroscopy, 2013
- Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplastyTransfusion, 2013
- Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 PatientsClinical Orthopaedics & Related Research, 2012
- Effectiveness and Safety of Tranexamic Acid in Reducing Blood Loss in Total Knee ArthroplastyThe Journal of Bone & Joint Surgery, 2012
- The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplastyKnee Surgery, Sports Traumatology, Arthroscopy, 2012
- The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysisKnee Surgery, Sports Traumatology, Arthroscopy, 2011
- Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelinesBritish Journal of Anaesthesia, 2011