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Intravenous tranexamic acid only versus combined intravenous and intra-articular tranexamic acid for perioperative blood loss in patients undergoing total knee arthroplasty

  • Original Article • KNEE -ARTHROPLASTY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

This study was performed to assess the effectiveness of the combined intravenous and intra-articular tranexamic acid (TXA) regimen in total knee arthroplasty (TKA).

Methods

The perioperative blood loss in 75 consecutive patients undergoing unilateral TKA that received both 1000 mg of TXA intravenously and 1000 mg of intra-articular TXA (combined TXA group) was compared with a consecutive series of 77 patients that received 1000 mg of TXA intravenously (intravenous TXA group). An additional 1000 mg of intravenous TXA was administered 6 h after the initial administration in both groups. Neither a pneumatic tourniquet nor drain was used. The primary outcome was the perioperative blood loss at 3 days after TKA calculated using the blood volume and change in haemoglobin from the preoperative value.

Results

The perioperative blood loss was significantly lower in the combined TXA group at 3 days after TKA than the intravenous TXA group (686 ± 303 vs. 830 ± 317 mL; 95% CI 44–244 mL; p = 0.0049). The perioperative blood loss was also lower in the combined TXA group at 1 and 7 days after TKA (374 ± 265 vs. 459 ± 226 mL; 95% CI 7–165 mL; p = 0.034 and 751 ± 320 vs. 871 ± 327 mL; 95% CI 16–224 mL; p = 0.024, respectively). No thrombotic events were observed during the study periods.

Conclusions

Combined intra-articular and intravenous TXA regimen significantly reduced perioperative blood loss compared with only intravenous TXA until 7 days after TKA.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo-ku, Niigata, Niigata, 950-1151, Japan

    Takuya Iseki, Sachiyuki Tsukada & Motohiro Wakui

  2. Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, 663-8501, Japan

    Takuya Iseki & Shinichi Yoshiya

  3. Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan

    Sachiyuki Tsukada

Authors
  1. Takuya Iseki
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  2. Sachiyuki Tsukada
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  3. Motohiro Wakui
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  4. Shinichi Yoshiya
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Correspondence to Sachiyuki Tsukada.

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The authors declare that they did not receive and will not receive any benefits or funding from any commercial party related directly or indirectly to the subject of this article.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Iseki, T., Tsukada, S., Wakui, M. et al. Intravenous tranexamic acid only versus combined intravenous and intra-articular tranexamic acid for perioperative blood loss in patients undergoing total knee arthroplasty. Eur J Orthop Surg Traumatol 28, 1397–1402 (2018). https://doi.org/10.1007/s00590-018-2210-2

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  • DOI: https://doi.org/10.1007/s00590-018-2210-2

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