Skip to main content
Log in

The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

An Erratum to this article was published on 06 February 2013

Abstract

Purpose

Reduction in blood loss during surgery stabilizes hemodynamic status and aids in recovery after total knee arthroplasty (TKA). In this study, the authors examined whether different administration routes of tranexamic acid (TNA) might affect the amount of blood loss after TKA.

Methods

A total of 150 patients were prospectively allocated to each of the three groups (intravenous, intra-articular, and placebo group) and underwent unilateral TKA. During closing the operative wound, TNA (1.5 g mixed in 100 cc of saline) was administered intravenously or intra-articularly according to the enrolled group, and an equivalent volume of normal saline was administered into the knee joint cavity and intravenously in the placebo group, respectively. The amount of blood loss and transfusion, and changes in haemoglobin levels were documented accordingly.

Results

The mean blood loss in the intravenous, intra-articular, and placebo groups were 528 ± 227, 426 ± 197, and 833 ± 412 ml, respectively. About 66 % (intravenous), 80 % (intra-articular), and 6 % (placebo) of each group did not require transfusion for any reason, and the mean amount of transfusion was 273.6, 129.6, and 920.8 ml, respectively. Preoperative haemoglobin values decreased by 1.6 ± 0.8, 1.8 ± 0.8, and 2.0 ± 0.9 mg/dl, respectively.

Conclusion

Compared to intravenous administration, intra-articular administration of TNA seems to be more effective in terms of reducing blood loss and transfusion frequency. TNA may improve the general conditions of patients given TKA by maintaining a hemodynamically stable state, aiding in recovery, and reducing the chance of transfusion-associated side effects and complications.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abrishami A, Chung F, Wong J (2009) Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis. Can J Anaesth 56:202–212

    Article  PubMed  Google Scholar 

  2. Álvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F (2008) Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion 48:519–525

    Article  PubMed  Google Scholar 

  3. Barsoum WK, Klika AK, Murray TG, Higuera C, Lee HH, Krebs VE (2011) Prospective randomized evaluation of the need for blood transfusion during primary total hip arthroplasty with use of a bipolar sealer. J Bone Joint Surg Am 93:513–518

    Article  PubMed  Google Scholar 

  4. Benoni G, Fredin H (1996) Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 78:434–440

    PubMed  CAS  Google Scholar 

  5. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee. J Bone Joint Surg Am 81:2–10

    PubMed  CAS  Google Scholar 

  6. Bong M, Patel V, Chang E, Issack P, Hebert R, Di Cesare P (2004) Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 19:281–287

    Article  PubMed  Google Scholar 

  7. Camarasa MA (2006) Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth 96:576–582

    Article  PubMed  CAS  Google Scholar 

  8. Diamond PT, Conaway MR, Mody SH, Bhirangi K (2006) Influence of hemoglobin levels on inpatient rehabilitation outcomes after total knee arthroplasty. J Arthroplasty 21:636–641

    Article  PubMed  Google Scholar 

  9. Fawzy H, Elmistekawy E, Bonneau D, Latter D, Errett L (2009) Can local application of tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial. J Cardiothorac Surg 4:25

    Article  PubMed  Google Scholar 

  10. Gibbons CE, Solan MC, Ricketts DM, Patterson M (2001) Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial. Int Orthop 25:250–252

    Article  PubMed  CAS  Google Scholar 

  11. Gill JB, Chin Y, Levin A, Feng D (2008) The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am 90:2399–2407

    Article  PubMed  Google Scholar 

  12. Good L, Peterson E, Lisander B (2003) Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 90:596–599

    Article  PubMed  CAS  Google Scholar 

  13. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemela HM, Mantyla SK, Kuisma RP, Ylinen JE (1997) Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 84:839–844

    PubMed  CAS  Google Scholar 

  14. Hippala S, Strid L, Wennerstrand M, Arvela V, Mantyla S, Ylinen J (1995) Tranexamic acid (Cyklokapron) reduces perioperative blood loss. Br J Anaesth 74:534–537

    Article  Google Scholar 

  15. Ishida K, Matsumoto T, Tsumura N, Kubo S, Kitagawa A, Chin T, Iguchi T, Kurosaka M, Kuroda R (2011) Mid-term outcomes of computer-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1107–1112

    Article  PubMed  Google Scholar 

  16. Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, Kubo S, Matsumoto T, Matsushita T, Chin T, Iguchi T, Kurosaka M, Kuroda R (2011) Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 35:1639–1645

    Article  PubMed  Google Scholar 

  17. Juelsgaard P, Larsen UT, Sorensen JV, Madsen F, Soballe K (2001) Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Reg Anesth Pain Med 26:105–110

    PubMed  CAS  Google Scholar 

  18. Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W (2009) Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res 123:687–696

    Article  PubMed  CAS  Google Scholar 

  19. Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ (2005) Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br 87:1480–1482

    PubMed  CAS  Google Scholar 

  20. Krohn CD, Sorensen R, Lange JE, Riise R, Bjornsen S, Brosstad F (2003) Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery. Eur J Surg 588:57–61

    Google Scholar 

  21. Levy O, Martinowitz U, Oran A, Tauber C, Horoszowski H (1999) The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty. A prospective, randomized, multicenter study. J Bone Joint Surg Am 81:1580–1588

    PubMed  CAS  Google Scholar 

  22. Lin PC, Hsu CH, Chen WS, Wang JW (2011) Does tranexamic acid save blood in minimally invasive total knee arthroplasty? Clin Orthop Relat Res 469:1995–2002

    Article  PubMed  Google Scholar 

  23. Molloy DO, Archbold HA, Ogonda L, McConway J, Wilson RK, Beverland DE (2007) Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial. J Bone Joint Surg Br 89:306–309

    PubMed  CAS  Google Scholar 

  24. Napolitano LM (2005) Perioperative anemia. Surg Clin N Am 85:1215–1227

    Google Scholar 

  25. Onodera T, Majima T, Sawaguchi N, Kasahara Y, Ishigaki T, Minami A (2012) Risk of deep venous thrombosis in drain clamping with tranexamic acid and carbazochrome sodium sulfonate hydrate in total knee arthroplasty. J Arthroplasty 27:105–108

    Article  PubMed  Google Scholar 

  26. Parvizi J, Chaudhry S, Rasouli MR, Pulido L, Joshi A, Herman JH, Rothman RH (2011) Who needs autologous blood donation in joint replacement? J Knee Surg 24:25–31

    Article  PubMed  Google Scholar 

  27. Sasanuma H, Sekiya H, Takatoku K, Takada H, Sugimoto N, Hoshino Y (2011) Efficient strategy for controlling postoperative hemorrhage in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:921–925

    Article  PubMed  Google Scholar 

  28. Seo JG, Moon YW, Lim JS, Park SJ, Kim SM (2011) Mechanical axis-derived femoral component rotation in extramedullary total knee arthroplasty: a comparison between femoral transverse axis and transepicondylar axis. Knee Surg Sports Traumatol Arthrosc 20:538–545

    Article  PubMed  Google Scholar 

  29. Sindet-Pedersen S, Ramström G, Bernvil S, Blombäck M (1989) Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N Engl J Med 320:840–843

    Article  PubMed  CAS  Google Scholar 

  30. Sukeik M, Alshryda S, Haddad FS, Mason JM (2011) Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br 93:39–46

    PubMed  CAS  Google Scholar 

  31. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S (2001) Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 83:702–705

    Article  PubMed  CAS  Google Scholar 

  32. Tse E, Cheung W, Ng K, Luk K (2011) Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am 93:1268–1277

    Article  PubMed  Google Scholar 

  33. Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, Syed KA, Muhammad Ovais Hasan S, De Silva Y, Chung F (2010) Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 92:2503–2513

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sang-Hoon Park.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seo, JG., Moon, YW., Park, SH. et al. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21, 1869–1874 (2013). https://doi.org/10.1007/s00167-012-2079-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2079-2

Keywords

Navigation