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Tranexamic acid in primary total knee arthroplasty without tourniquet: a randomized, controlled trial of oral versus intravenous versus topical administration

Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China. Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China. Department of Cosmetic Plastic and Burns surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China. Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China. Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China. Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China. Key laboratory of Obstetric and Gynecologic and Pediatric Disease and Birth Defects (Ministry of Education), West China Second University Hospital, Sichuan University, Chengdu, 610041, P.R. China. 562372162@qq.com. Quality Assessment Office, West China Second University Hospital, Sichuan University, Chengdu, 610041, P.R. China. 562372162@qq.com. Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China. zongkehx@163.com. Center for Joint Surgery, Southwest Hospital, Third Military Medical University, 30# Gaotanyan Street, Chongqing, 400038, P.R. China. weinanzeng@163.com.

Scientific Reports. 2018;8((1)):13579.
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Abstract
Abundant literature confirms that intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) reduces blood loss in total knee arthroplasty (TKA). Oral formulations of TXA exhibit profound cost-saving benefits. However, comparisons of the clinical efficacy among three different modalities of TXA administration have not been previously investigated in the setting of TKA with no closed suction drain and tourniquet. A total of 180 patients undergoing TKA were randomized to receive 2-g oral TXA 2 hours preoperatively, 20-mg/kg IV TXA 5 minutes prior to incision, or 2-g IA TXA. The primary outcome was 72-hour blood loss. Secondary outcomes were reductions in hemoglobin, the rate of transfusions, and adverse events. No significant differences were identified with regard to the mean 72-hour blood loss among the three groups (1003 mL in oral group, 1108 mL in IV group, and 1059 mL in IA group, respectively). Similarly, hemoglobin reduction was equivalent among the groups. Only one patient in IV group exhibited deep venous thrombosis. No difference was identified regarding transfusion rates. Oral TXA results in similar blood loss in TKA, with a profound cost-saving benefit, compared with the IA and IV formulations.
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Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine