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

  • Takuya Iseki
  • Sachiyuki TsukadaEmail author
  • Motohiro Wakui
  • Shinichi Yoshiya
Original Article • KNEE -ARTHROPLASTY



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


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.


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.


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


Knee Primary arthroplasty Blood loss Tranexamic acid Transfusion 


Compliance with ethical standards

Conflict of interest

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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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryNekoyama Miyao HospitalNiigataJapan
  2. 2.Department of Orthopaedic SurgeryHyogo College of MedicineNishinomiya CityJapan
  3. 3.Department of Orthopaedic SurgeryHokusuikai Kinen HospitalMitoJapan

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