Low-dose exposure to tranexamic acid has no significant toxic effect on human cartilage

Recent studies have raised concerns about the potential cytotoxic effects of tranexamic acid (TXA) on cartilage. This study aimed to evaluate the safety of low-dose TXA exposure on human cartilage.

In this ex-vivo study, 30 patients with a varus osteoarthritic knee undergoing total knee arthroplasty (TKA) were enrolled. During the surgery, a set of six osteochondral plugs was harvested from the apparently intact lateral condyle of each patient's femur, resulting in a total of 180 plugs. Subsequently, all three plugs of each set were randomly exposed to one of the TXA treatment groups: 1 mg/ml (TI group), 5 mg/ml (TV group), or 10 mg/ml (TX group) of TXA. The remaining three plugs of each set were assigned to the control group and exposed to 0.9 % saline as a match for comparison. The effects of TXA dose and exposure time on cell viability were assessed using acridine orange/propidium iodide staining at baseline, 3, and 6 h post-exposure.

Cell viability decreased over time in the TI, TV, TX, and control groups compared with their baselines (P = 0.006, P < 0.001, P = 0.001, P < 0.001, respectively). However, the differences in the trend of decline were not statistically significant between groups (P = 0.3), and direct comparisons among TXA concentrations and saline control at baseline, 3, and 6 h after exposure showed no statistically significant difference in cell death (P = 0.538, P = 0.256, P = 0.287, respectively).

Exposure to low-dose TXA (≤10 mg/ml) for up to 6 h did not cause significant toxic effects on human cartilage.