Intra-articular 1 g tranexamic acid administration during total knee arthroplasty is safe and effective for the reduction of blood loss and blood transfusion

• Published in: European journal of orthopaedic surgery & traumatology 2019-12, Vol.29 (8), p.1737-1741
• Main Authors: Kamatsuki, Yusuke, Miyazawa, Shinichi, Furumatsu, Takayuki, Kodama, Yuya, Hino, Tomohito, Okazaki, Yoshiki, Masuda, Shin, Okazaki, Yuki, Ozaki, Toshifumi
• Format: Article
• Language: English
• Subjects: Aged; Antifibrinolytic agents; Antifibrinolytic Agents - administration & dosage; Antifibrinolytic Agents - adverse effects; Arthroplasty, Replacement, Knee; Blood Transfusion; Blood transfusions; Blood Volume; Contrast Media; Female; Health risk assessment; Hemoglobins - metabolism; Humans; Injections, Intra-Articular; Joint surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article • KNEE - ARTHROPLASTY; Postoperative Hemorrhage - blood; Postoperative Hemorrhage - prevention & control; Pulmonary Embolism - chemically induced; Pulmonary Embolism - diagnostic imaging; Retrospective Studies; Surgical Orthopedics; Tomography, X-Ray Computed; Tranexamic Acid - administration & dosage; Tranexamic Acid - adverse effects; Traumatic Surgery; Venous Thrombosis - chemically induced; Venous Thrombosis - diagnostic imaging
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-019-02520-5

Introduction The effect of tranexamic acid (TXA) on the incidence of venous thromboembolic events (VTEs) in total knee arthroplasty (TKA) as assessed by contrast-enhanced computed tomography (CT) is unclear. Thus, we investigated the efficacy and safety profiles of TXA administration during TKA. We hypothesised that intra-articular 1 g TXA administration would have a sufficient effect on the reduction of blood loss and transfusion rates without increasing VTE risk. Materials and methods We retrospectively analysed 86 patients who underwent primary TKA from January 2014 to September 2017. The study comprised control ( n  = 45) and TXA ( n  = 41) groups. All patients underwent navigation-assisted TKA via the medial parapatellar approach. In those who received TXA, 1 g of intra-articular TXA was injected via a drain immediately following wound closure. The drain was clamped for 2 h and then reopened. Contrast-enhanced CT was performed 5–6 days after surgery to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). Blood loss was calculated using the haemoglobin balance method. Results The mean postoperative volume of blood loss was 900 ± 296 mL vs 1216 ± 445 mL in the TXA vs control group ( p   0.05). No case of symptomatic PE occurred. Conclusions This study demonstrated that intra-articular 1 g TXA administration during TKA is safe and effective for reducing blood loss and blood transfusion without increasing VTE risk.