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Tranexamic Acid in Knee Surgery Study-A Multicentered, Randomized, Controlled Trial.

Marinus D J Stowers1, James Aoina2, Andrew Vane2

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Tranexamic acid (TXA) effectively reduces blood loss in total knee arthroplasty (TKA) when administered topically or systemically. This study found no significant difference in blood loss between the two administration routes, offering valuable insights for TKA procedures.

Keywords:
TRACKSblood transfusionestimated blood lossperioperative caretotal knee arthroplastytranexamic acid

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Area of Science:

  • Orthopedic Surgery
  • Anesthesiology
  • Pharmacology

Background:

  • Postoperative anemia after elective arthroplasty can prolong recovery and is poorly tolerated by patients with cardiovascular disease.
  • Tranexamic acid (TXA) is known to reduce blood loss during total knee arthroplasty (TKA).
  • The optimal administration route for TXA in TKA remains unclear.

Purpose of the Study:

  • To compare the efficacy of topical versus systemic administration of tranexamic acid (TXA) in reducing perioperative blood loss during total knee arthroplasty (TKA).
  • To evaluate the safety and effectiveness of a single intraoperative dose of TXA.

Main Methods:

  • A double-blinded, placebo-controlled, multicenter randomized trial was conducted.
  • 134 patients undergoing primary, unilateral TKA were randomized into three groups: topical TXA (tTXA), systemic TXA (sTXA), or placebo.
  • The primary outcome was estimated perioperative blood loss, analyzed using an intention-to-treat approach.

Main Results:

  • Both topical TXA (723 mL) and systemic TXA (749 mL) significantly reduced blood loss compared to placebo (1090 mL) (P < .001).
  • No significant difference in blood loss was observed between the topical and systemic TXA groups.
  • Secondary outcomes, including deep vein thrombosis and pulmonary embolism rates, showed no significant differences between groups.

Conclusions:

  • A single intraoperative dose of 1.5 g of tranexamic acid (TXA) is effective in reducing blood loss during elective total knee arthroplasty (TKA).
  • Both topical and systemic administration routes are equally effective.
  • TXA administration, via either route, does not increase complications in TKA patients.