Skip to main content


Log in

Does tranexamic acid increase the risk of thromboembolism after bilateral simultaneous total knee arthroplasties in Asian Population?

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript



To ascertain whether tranexamic acid reduces the blood loss and transfusion rate and volumes; increase the prevalence of deep vein thrombosis (DVT); and investigate factors associated with DVT in patients undergoing primary bilateral total knee arthroplasties (TKAs) without use of chemical thromboprophylaxis.


There were 874 patients (1748 knees) in the control group who did not receive tranexamic acid and 871 patients (1742 knees) in the study group who received tranexamic acid. Mechanical compression device was applied without any chemical thromboprophylaxis. Transfusion rates and volumes were recorded. DVT was diagnosed using both sonogram and venogram at 7 or 8 day post-operatively.


Intra- and post-operative blood loss and transfusion volumes were significantly lower in the tranexamic acid group. The prevalence of DVT was 14% (245 of 1748 knees) in the control group and 18% (314 of 1742 knees) in the tranexamic acid group. Pre- and post-operative perfusion lung scans revealed no evidence of PE in any patients in either group. Coagulation or thrombophilic data or molecular genetic testing was not significantly different between the two groups.


The use of tranexamic acid reduces the volume of blood transfusion and does not increase the prevalence of DVT or PE in the patients who did not receive routine chemical thromboprophylaxis after primary bilateral simultaneous sequential TKAs in Asian patients.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others


  1. Aguilera X, Martinez-Zapata MJ, Hinarejos P, Jordán M, Leal J, González JC, Monllau JC, Celaya F, Rodriquez-Arias A, Fernández JA, Pelfort X, Puig-Verdie LI (2015) Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial. Arch Orthop Trauma Surg 135:1017

    Article  CAS  PubMed  Google Scholar 

  2. Benoni G, Fredin H, Knebel R, Nilsson P (2001) Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop Scand 72:442

    Article  CAS  PubMed  Google Scholar 

  3. Cid J, Lozano M (2005) Tranexamic acid reduces allogenic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion 45:1302

    Article  CAS  PubMed  Google Scholar 

  4. Ellis MH, Fredman B, Zohar E, Ifrach N, Jedeikin R (2003) The effect of tourniquet application, tranexamic acid, and desmopressin on the procoagulant and fibrinolytic systems during total knee replacement. Br J Anaesth 90:596

    Article  Google Scholar 

  5. Graham ID, Alvarez G, Tetrol J, McAuley L, Lasepacis A (2002) Factors influencing the adoption of blood alternatives to minimize allogenic transfusion: the perspective of eight Ontario hospitals. Can J Surg 45:132

    PubMed  PubMed Central  Google Scholar 

  6. Ho KM, Ismail H (2003) Use of intravenous tranexamic acid to reduce allogenic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anesth Intensive care 31:529

    CAS  Google Scholar 

  7. Hourlier H, Reina N, Fennema P (2015) Single dose intravenous tranexamic acid as effective as continuous infusion in primary total knee arthroplasty: a randomized clinical trial. Arch Orthop Trauma Surg 135:465–471

    Article  PubMed  Google Scholar 

  8. Husted H, Blond L, Sonne-Holm S, Holm G, Jacobsen TW, Gebuhr P (2003) Tranexamic acid reduces blood loss and blood transfusion in primary total hip arthroplasty: a prospective randomized double-blind study in 40 patients. Acta Orthop Scand 74:665–669

    Article  PubMed  Google Scholar 

  9. Hynes M, Calder P, Scott G (2003) The use of tranexamic acid to reduce the blood loss during total knee arthroplasty. Knee 10:375–377

    Article  CAS  PubMed  Google Scholar 

  10. Ido K, Neo M, Asada Y, Kondo K, Morita T, Sakamoto T, Hayashi R, Kuriyama S (2000) Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties. Arch Orthop Trauma Surg 120:518–520

    Article  CAS  PubMed  Google Scholar 

  11. Irwin A, Khan SK, Jameson SS, Tate RC, Copeland C, Reed MR (2013) Oral versus intravenous tranexamic acid in enhanced-recovery primary total hip and knee replacement. Results of 3000 procedures. Bone Joint J 95:1556–1561

    Article  PubMed  Google Scholar 

  12. Jain NP, Nisthane PP, Shah NA (2016) Combined administration of systemic and topical tranexamic acid for total knee arthroplasty: can it be a better regimen and yet safe? A randomized controlled trial. J Arthroplast 31:542–547

    Article  Google Scholar 

  13. Johansson T, Pettersson LG, Lisander B (2005) Tranexamic acid in total hip arthroplasty saves blood and money: a randomized double-blind study in 100 patients. Acta Orthop 76:314–319

    PubMed  Google Scholar 

  14. Kagoma YK, Crowther MA, Douketis J, Bhandan M, Eihelboom 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  CAS  PubMed  Google Scholar 

  15. Kim Y-H, Kim J-S (2002) Incidence and natural history of deep-vein thrombosis after total knee arthroplasty. A prospective randomized study. J Bone Joint Surg Br 84:566–570

    Article  PubMed  Google Scholar 

  16. Kim Y-H, Yoo J-H, Kim J-S (2007) Factors leading to decreased rates of deep vein thrombosis and pulmonary embolism after total knee arthroplasty. J Arthroplast 22:974–980

    Article  Google Scholar 

  17. Kim Y-H (1990) Incidence of deep vein thrombosis after cementless and cemented knee replacement. J Bone Joint Surg Br 72:779–783

    CAS  PubMed  Google Scholar 

  18. Lemay E, Guay J, Côté C, Roy A (2004) Tranexamic acid reduces the need for allogenic red blood cell transfusion in patients undergoing total hip replacement. Can J Anaesth 51:31

    Article  PubMed  Google Scholar 

  19. Lindoff C, Rybo G, Astedt B (1993) Treatment with tranexamic acid during pregnancy, and the risk of thrombo-embolic complications. Thromb Haemost 70:238–240

    CAS  PubMed  Google Scholar 

  20. Martin JG, Cassatt KB, Kincaid-Cinnamon KA, Westendorf DS, Garton AS, Lemke JH (2014) Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplast 29:889–894

    Article  Google Scholar 

  21. Shemshaki H, Nourian SM, Nourian SM, Nourian N, Dehghani M, Mokhtari M, Mazoochian F (2015) One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Arch Orthop Trauma Surg 135:573–588

    Article  PubMed  Google Scholar 

  22. Wong J, Abrishami A, Beheiry HEL, Mahomed NN, Davey R, Gandhi R, Syed KA, Hasan SMO, Silva YD, Chung F (2010) Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty. J Bone Joint Surg Am 92:2503–2513

    Article  PubMed  Google Scholar 

  23. Xie J, Ma J, Kang P, Zhou Z, Shen B, Yang J, Pei F (2015) Does tranexamic acid alter the risk of thromboembolism following primary total knee arthroplasty with sequential earlier anticoagulation? A large, single center, prospective cohort study of consecutive cases. Thromb Res 136:234–238

    Article  CAS  PubMed  Google Scholar 

  24. Yang ZG, Chen WP, Wu LD (2012) Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 94:1153–1159

    Article  PubMed  Google Scholar 

  25. Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S (2006) Do antifibrinolytics reduce allogenic blood transfusion in orthopedic surgery? Anesthesiology 105:1034–1046

    Article  PubMed  Google Scholar 

Download references


There is no funding source.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Young-Hoo Kim.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article contains studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, YH., Park, JW., Kim, JS. et al. Does tranexamic acid increase the risk of thromboembolism after bilateral simultaneous total knee arthroplasties in Asian Population?. Arch Orthop Trauma Surg 138, 83–89 (2018).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: