Intra-Articular Injection of Tranexamic Acid to Reduce Blood Loss after Total Knee Arthroplasty

Abstract

Intra-articular administration of TXA is effective in reducing blood loss after TKA, without increasing the risk of VTE.

Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients

“…The TXA also decreased the number of the packed red blood cell transfusion per patient. Routes of administration of TXA are different in the literature such as intra-articular, 17 intravenous, and oral, 18 with no literature showing one route to be superior to another.…”

Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty: Meta-analysis

“…The remaining 41 articles are included in this article as either background or supportive material (n ¼ 25) 2, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][25][26][27][28][29][30][31] or as the quantitative meta-analysis (n ¼ 16). 1,3,23,24,[32][33][34][35][36][37][38][39][40][41][42][43] The study selection is shown in the PRISMA flowchart (►Fig. 1).…”

“…Eight of the 16 studies included in the meta-analysis were blinded randomized controlled trials, CEBM Level I, 32,34,36,[38][39][40]42,43 1 study was a nonblinded randomized controlled trial, CEBM Level II, 41 and the remaining 7 studies were case-controlled trials, CEBM Level III 1,3,23,24,33,35,37 (►Table 1). Sample sizes ranged from 24 to 373 patients receiving unilateral TKAs, a total of 2,610 patients (1,339 IA-TXA and 1,271 placebo) were enrolled in the 16 studies.…”

“…TXA was injected into the joint capsule in seven studies consisting of 491 IA-TXA TKAs, 24,35,[37][38][39][40]43 and in the other nine studies consisting of 848 IA-TXA TKAs, the knee was either irrigated or bathed with TXA before capsule closure. 1,3,23,[32][33][34][35]41,42 The dosage and concentration of TXA used for intra-articular injection or irrigation was quite varied, two studies examined the effect of dosage. 40,42 Nine studies used postsurgical drains; these were often clamped post-TKA.…”

“…40,42 Nine studies used postsurgical drains; these were often clamped post-TKA. 24,32,[35][36][37][38][39][40][41] Transfusion trigger was usually defined to be post-TKA hemoglobin less than 7 or 8 g/dL for nonsymptomatic patients and less than 8 or 10 g/dL for patients who were symptomatic for anemia or who had comorbidities. The most common method of calculating total blood loss was the use of the Nadler's formula incorporating hemoglobin balance.…”