Topical Tranexamic Acid Reduces Blood Loss in Minimally Invasive Total Knee Arthroplasty Receiving Rivaroxaban

Abstract

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.

Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

“…Wood et al [ 20 ] also reported a significantly reduced need for transfusion in the same patient group. Similar results with intraarticular TXA were produced by Wang et al [ 22 ] with a dose of 0.5 g in a 10 mL solution, and Yen et al [ 27 ] with a dose of 3 g in a 100 mL solution.…”

Use of Topical Tranexamic Acid to Reduce Blood Loss in Single-Level Transforaminal Lumbar Interbody Fusion

“…These potential side effects have generated a new interest in TXA application for hemorrhage control, as the surgical site has maximum fibrinolysis activity and persists through the perioperative period. The role of topical TXA is well established in orthopedic reconstructive and cardiac surgeries [8,9,11,12]. In this study, there was a substantial decrease in the intraoperative blood loss (47.7%): drain output on day 1 was 35.93% and 45.7% on day 2.…”

“…Prolonged operative time (especially in spine surgery) has a higher rate of these complications [5]. In recent years, reducing perioperative blood loss and transfusions in spine surgery has become increasingly important, and various studies have explored the efficacy of topically applied TXA at the surgical site [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Topical TXA has the advantage of direct and high local concentration at the bleeding site, and the risks associated with systemic administration are avoided.…”

Effect of Intra Articular Tranexamic Acid Use on Post-Operative Blood Loss in Unilateral Primary Total Knee Arthroplasty (TKA)

“…Yen et al found that the mean blood loss was 1131±336ml in placebo group while 921±252ml with intravenous Tranexamic acid while 795±231 ml with intra articilar Tranexamic acid. (p<0.01) [20].…”