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Updated: Feb 16, 2026

Knee Arthrocentesis in Adults
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Tranexamic Acid Prophylaxis in Hip and Knee Joint Replacement.

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    Deutsches Arzteblatt International
    |December 19, 2017
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    Prophylactic tranexamic acid (TXA) significantly reduces bleeding and transfusion needs in hip and knee replacement surgery. Complications are rare, but TXA is contraindicated in patients with recent thromboembolic events or epilepsy.

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    Area of Science:

    • Orthopedic Surgery
    • Anesthesiology
    • Pharmacology

    Background:

    • Tranexamic acid (TXA) is an antifibrinolytic agent used to manage hyperfibrinolytic states and prevent hemorrhage.
    • It is commonly employed in severe polytrauma and elective orthopedic procedures.
    • This review focuses on TXA's use before major hip and knee endoprosthetic surgery.

    Purpose of the Study:

    • To evaluate the efficacy of prophylactic tranexamic acid administration.
    • To assess the risks associated with its use in major endoprosthetic hip and knee surgery.

    Main Methods:

    • A selective literature search was conducted in PubMed and Cochrane Library databases.
    • Pertinent articles were retrieved and analyzed for relevant data.

    Main Results:

    • Prophylactic TXA significantly reduces intra- and postoperative bleeding in hip and knee endoprosthetic surgery.
    • It also decreases the likelihood of blood transfusion, with NNTs ranging from 3.7-8.2.
    • Thromboembolic event rates did not differ significantly from placebo; epileptic seizures are unlikely at standard doses.

    Conclusions:

    • Intravenous tranexamic acid effectively reduces bleeding and transfusion requirements in endoprosthetic hip and knee procedures.
    • Complications are generally rare, but contraindications include recent urogenital bleeding, pulmonary embolism, myocardial infarction, recent PCI, or known epilepsy.