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Optimal dose of topical tranexamic acid considering efficacy and safety in total knee arthroplasty: a randomized controlled study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to evaluate the optimal dosage of topical tranexamic acid (TXA) considering the efficacy and safety for controlling bleeding after total knee arthroplasty (TKA).

Methods

This prospective randomized double-blinded placebo-controlled comparative study included 325 patients scheduled to undergo TKA, who were randomly assigned to five groups based on the topical TXA injection (n = 65 per group): control; group 1, 0.5 g TXA; group 2, 1.0 g TXA; group 3, 2.0 g TXA; and group 4, 3.0 g TXA. The primary outcome was decrease in postoperative hemoglobin levels. The secondary outcomes were blood loss calculated using Good’s method, drainage volume, frequency of transfusion, and range of motion (ROM). Plasma TXA levels and complications were also evaluated.

Results

Significant differences were noted in the decrease in hemoglobin levels between the control group and groups 2 (p = 0.0027), 3 (p = 0.005), and 4 (p = 0.001). No significant differences were shown among the experimental groups. Significant differences in total blood loss and frequency of transfusion were noted between the control group and groups 2 (p = 0.004, 0.002, respectively), 3 (p = 0.007, 0.001, respectively), and 4 (p = 0.001, 0.009, respectively) without showing significant differences among the experimental groups. With respect to drainage volume, no significant differences were observed among the groups. The serum TXA levels increased proportionally with the applied dose of topical TXA immediately and at 3 and 6 h postoperatively. Symptomatic deep vein thrombosis or pulmonary embolism was not observed in any group. Other complications related to TXA administration were not detected.

Conclusion

Topical application of 1.0 g or more of TXA shows significant bleeding control without a dose–response relationship. Blood TXA levels increase with the TXA dose following topical TXA application. Therefore, to prevent overdosing and reduce potential complications with ensuring the effectiveness, 1.0 g of TXA is recommended as a topical application.

Level of evidence

I.

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Acknowledgements

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Funding

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF-2017R1A2B4011966).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, South Korea

    Jong-Keun Kim

  2. Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Jae-Young Park, Do Yoon Lee, Du Hyun Ro, Hyuk-Soo Han & Myung Chul Lee

Authors
  1. Jong-Keun Kim
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  2. Jae-Young Park
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  4. Du Hyun Ro
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  5. Hyuk-Soo Han
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Contributions

Jong-Keun Kim: contributed to progressing of research, statistical analysis, and writing and editing of the manuscript. Jae-Young Park: contributed to data analysis and editing of the manuscript. Do Yoon Lee: contributed to data analysis and editing of the manuscript. Du Hyun Ro: contributed to data analysis and editing of the manuscript. Hyuk-Soo Han: contributed to planning data analysis, and editing of the manuscript. Myung Chul Lee: performed the surgery, contributed to planning, statistical analysis, and writing and editing of the manuscript.

Corresponding author

Correspondence to Myung Chul Lee.

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Nothing to declare.

Ethical approval

This study was approved by the institutional review board at Seoul National Unversity Hospital (1511–118-723) and registered at cris.nih.go.kr (KCT0004298).

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Kim, JK., Park, JY., Lee, D.Y. et al. Optimal dose of topical tranexamic acid considering efficacy and safety in total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 29, 3409–3417 (2021). https://doi.org/10.1007/s00167-020-06241-9

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