Effectiveness and safety of tranexamic acid administration during total knee arthroplasty

The administration of tranexamic acid (TA) is associated with a decrease in the number of red blood cell (RBC) units transfused. However, concerns about its safety have hindered its broader use.

We evaluated the effect of TA on RBC transfusion and thromboembolic complications in total knee arthroplasty. We retrospectively studied 414 patients, 215 immediately before introducing TA treatment (control group) and after, in 199 patients without history of thromboembolic diseases (TA group). In a subgroup of patients, a lower extremities contrast venography was performed.

Fifty-four per cent of control group patients were transfused with RBC while only 17.6% of TA group patients received RBCs. In the TA that group, those transfused received less units (2.83 vs. 1.89), showed smaller mean calculated perioperative blood loss and haemoglobin values at discharge were higher compared to control group (10.1 vs. 9.3 g/dl). Thromboembolic complications were diagnosed in 2.8% of the patients in the control group and in 1.5% in the TA group. Asymptomatic distal deep venous thrombosis was found in 54 (14.8%) of TA group patients and 54 (30.1%) of control patients. TA administration reduced the expenditure for RBC transfusion plus the cost of TA from 148.94 to 33.87 euro per patient.

Routine administration of TA during total knee arthroplasty to patients without history of thromboembolic disease is associated with a 67% reduction in RBC transfusions and, in those transfused, with a reduction in the number of units administered. TA treatment was not associated with an increase in thromboembolic complications. Transfusion costs are significantly reduced.