Background It is unclear whether topical (intra-articular) or intravenous TXA reduces blood loss in minimally invasive TKA patients receiving a direct oral anticoagulant for thromboprophylaxis. This study is to investigate whether TXA given intravenously or intra-articularly is effective in reducing blood loss in minimally invasive TKA patients using rivaroxaban for thromboprophylaxis. Methods Ninety-three patients who underwent primary minimally invasive TKA were divided into placebo group (30 patients) that received saline both intravenously and intra-articularly, intravenous (IV) group (31 patients) that received 1 g TXA intravenously, and topical group (32 patients) that received 3 g TXA in 100 ml saline intra-articularly. All patients received oral rivaroxaban of 10 mg daily for 14 days postoperatively. Results p < 0.001 and p = 0.041. The mean total blood loss was 1131 mL (567–1845) in placebo, which was higher than that in the IV group (921 mL; range, 465–1495; p = 0.014) and the topical group (795 mL; range, 336–1350; p < 0.001). The total blood loss did not differ between the IV and the topical group (p = 0.179). Conclusion This prospective, randomized, controlled trial demonstrated an equal efficacy of TXA in blood conservation when administered intravenously or topically in minimally invasive TKA patients receiving rivaroxaban for thromboprophylaxis.

As a result of the global population growth since World War II, and the major impact of the COVID-19 pandemic on the increase in the number of deaths, carbon emissions resulting from cremations in the funeral industry have increased by more than initially expected. In order to achieve the goal of the Kyoto Protocol and the Paris Agreement, to reach net-zero carbon neutrality by 2050, in this study, we comprehensively examined the literature on the differences in burial methods in terms of carbon emissions, and undertook stepwise analysis of the solution’s sequence from 1990 to 2050 using the recurrence relations in the trend changes using 5-year intervals. By collecting the annual number of global deaths and calculating the average carbon emissions per death to be 245 kg, we analyzed and compared these data with the annual carbon dioxide amount and global population until 2050. In addition, the results for cremation and Cryomation were analyzed and compared to construct a model of comparative advantage. The results of this study show that Cryomation is more energy efficient and has a greater impact on carbon emission reduction than cremation because it does not require carbon emission elements such as embalming or coffins. Thus, Cryomation can effectively reduce damage to the environment. Taking appropriate strategies for the funeral industry to promote Cryomation can achieve the goals of environmental protection and sustainable development.

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