[Effect of tranexamic acid on blood loss control in patients undergoing primary total knee arthroplasty]

Total knee arthroplasty (TKA) is an important surgical method for treating advanced knee osteoarthritis(KOA). It could effectively restore knee joint function and relieve pain. However, perioperative blood loss may cause postoperative anemia, increase the demand for blood transfusion, and thereby affect the prognosis of patients and increase medical burden. Tranexamic acid (TXA), as an anti-fibrinolytic agent, plays a significant role in controlling blood loss during perioperative period of TKA. TXA mainly works by competitively inhibiting the binding of plasminogen to fibrin, thereby preventing fibrin degradation. This reduces the amount of blood loss during and after operation, lowers blood transfusion rate, and does not affect patient's coagulation function. Studies have confirmed that TXA could significantly reduce blood loss during perioperative period of TKA. Whether administered systemically, topically, or in combination, it could effectively decrease total blood loss and the rate of blood transfusion, without increasing the risk of adverse events such as thromboembolism, and has good safety. However, the administration route and dosage of TXA have significant impacts on therapeutic effect. At present, the optimal regimen still needs to be explored. Routes such as intravenous administration and intra-articular administration each have their own characteristics, and the dosage selection should take into account factors such as the patient's weight and surgical conditions. Currently, the research focus on the safety of TXA in high-risk patients (such as those with a history of thrombosis), the optimization of individualized dosing strategies, and its combined application with other hemostasis techniques. In general, TXA is an effective auxiliary measure for blood management during the perioperative period of TKA, which can improve patient prognosis and save medical costs. However, its long-term effects and applicability in specific populations still require more high-quality research to verify.