Original researchSafety and efficacy of intra-articular tranexamic acid injection without drainage on blood loss in total knee arthroplasty: A randomized clinical trial

- Major blood loss is unavoidable after primary total knee arthroplasty.
- This is double-blind, randomized, placebo-control trial.
- 60 patients treated with unilateral primary cement TKA in the trail.
- TXA treatment without drainage during TKA reduces the amount of blood transfusions required.

BackgroundMajor blood loss is unavoidable after primary total knee arthroplasty (TKA). The aim of this study was to determine if tranexamic acid (TXA) can reduce major blood loss following TKA.MethodsIn this double-blind, randomized, placebo-control trial, 60 patients treated with unilateral primary cement TKA between August 1st 2013 and September 30th 2013 were randomized into TXA 500 mg intra-articular injection without drainage (test group, 30 knees) and 30 patients with saline intra-articular injection (control group, 30 knees).ResultsThere was a significant reduction in mean blood loss (560.55 mL) between the groups at postoperative day (POD) 5 (999.22 mL vs. 1559.77 mL, P = 0.001). The maximum hemoglobin drop was identified at POD 3 (10.51 g/dL vs. 9.10 g/dL, mean difference = 1.41 g/dL). Also, there was a significant reduction in red blood cell and hematocrit loss (P = 0.001). The transfusion rates (0% vs. 23.3%, P = 0.011) and average amount transfused (0.00 ± 0.00 units vs. 0.53 ± 1.04 units, P = 0.009) were significantly lower in the TXA group compared with control group. No significant difference in coagulation marker changes were found between TXA and control groups (P > 0.05), but the D-dimer levels at 3 and 5 days post-TKA were statistically lower in the TXA group (P < 0.05). No significant changes in the rate of symptomatic deep venous thrombosis, pulmonary embolism, or wound healing problems were noted.ConclusionsTXA treatment without drainage during TKA reduces the amount of blood transfusions required without increasing the rate of adverse events.