Intravenous vs Topical Tranexamic Acid in Total Knee Arthroplasty Without Tourniquet Application: A Randomized Controlled Study

• Published in: The Journal of arthroplasty 2016-11, Vol.31 (11), p.2465-2470
• Main Authors: Tzatzairis, Themistoklis K., MD, Drosos, Georgios I., MD, PhD, Kotsios, Stamatios E., MD, Ververidis, Athanasios N., MD, PhD, Vogiatzaki, Theodosia D., MD, PhD, Kazakos, Konstantinos I., MD, PhD
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Administration, Topical; Aged; Antifibrinolytic Agents - administration & dosage; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; blood loss; Blood Loss, Surgical - prevention & control; Blood Loss, Surgical - statistics & numerical data; Demography; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Orthopedics; Osteoarthritis, Knee - surgery; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - prevention & control; Postoperative Period; Prospective Studies; Research Design; total knee arthroplasty; tourniquet; Tourniquets - adverse effects; tranexamic acid; Tranexamic Acid - administration & dosage; transfusion; Transfusion Reaction; without
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.04.036

Abstract Background Use of tranexamic acid (TXA) is effective and safe in reducing the blood loss in total knee arthroplasty (TKR) performed using a tourniquet, but, data in TKR performed without tourniquet are limited, and there is no study comparing the topical (T) with intravenous (IV) TXA administration. Our aim was to compare the topical (T) with intravenous (IV) TXA administration in TKR performed without tourniquet. Material and methods A total of 120 patients undergoing unilateral TKR for knee osteoarthritis were included in a prospective randomized study. Operations were performed under spinal anesthesia, no tourniquet was used, and the postoperative regime was the same for all patients. Patients were divided into 3 groups; in group C (control), 40 patients received no TXA, in group IV, 40 patients received 1 g of TXA intravenously, and in group L, 1 g of TXA was applied locally to 40 patients. The primary outcome measures included the calculated blood loss, the transfusion rate, and quantity of allogeneic blood units, whereas secondary outcome measures were complications. Results There was no statistically significant difference in patient's demographics and perioperative results. Calculated blood loss, allogeneic blood transfusion rate, and quantity in group C were significantly higher compared with those of TXA groups ( P < .001). There was no significant difference in complications rate between the 3 groups. Conclusions According to the results of this study, IV or T administration of 1-g TXA significantly reduced the blood loss and the need for allogeneic blood transfusion in patients undergoing TKR without a tourniquet (with no significant difference between the 2 routes of administration).