Tranexamic acid toxicity in human periarticular tissues.

Area of Science:

• Orthopaedic Surgery
• Cell Biology
• Pharmacology

Background:

• Tranexamic acid (TXA) is an anti-fibrinolytic medication used to minimize bleeding during surgery.
• Topical TXA administration via intra-articular injection or wash is increasingly common in orthopaedic procedures.
• Adult periarticular tissues have limited regenerative capacity, making them vulnerable to iatrogenic damage.

Purpose of the Study:

• To investigate the effects of clinically relevant concentrations of TXA on human periarticular tissues and primary cell cultures.
• To assess the impact of TXA on cell viability and apoptosis in tendon, synovium, and cartilage.

Main Methods:

• Human tendon, synovium, and cartilage explants were subjected to ex vivo and in vitro studies with varying TXA concentrations.
• Primary cultures of tenocytes, fibroblast-like synoviocytes, and chondrocytes were analyzed using MTT assays, fluorescent microscopy, and apoptotic arrays.

Main Results:

• A significant increase in cell death was observed in all tissue explants treated with 100 mg/ml TXA (p < 0.01).
• MTT assays showed a significant decrease in cell viability in all tissues after 4 hours of exposure to 50 mg/ml or 100 mg/ml TXA (p < 0.05).
• Significant apoptosis increase was noted in all tissues after 1 hour of exposure to 100 mg/ml TXA (p < 0.05).

Conclusions:

• TXA demonstrates significant toxicity to human periarticular tissues ex vivo and in vitro at commonly used clinical concentrations.
• The findings suggest a potential risk of tissue damage with topical TXA application during orthopaedic surgery.