Efficacy of Three Methods of Tranexamic Acid Administration in Reduction of Blood Loss Following Knee Arthroplasty

One of the common complications following total knee arthroplasty (TKA) is excessive post operative blood loss. Tranexamic acid (TXA)، an antifibrinolytic drug، is commonly used to control post-operative blood loss. However، the ideal route of administration is not yet quite clear. In this study، the different administration routes of TXA for blood loss control after TKA will be evaluated. In a clinical trial study، 200 patients who were scheduled for knee arthroplasty were randomly divided into 4 groups. In group 1، TXA (500 mg mixed in 100 cc of saline) was administered intravenously at the time of wound closure. In group 2، the knee joint cavity was irrigated and soaked for 5 minutes with 3 g of TXA in 100 cc of saline just before wound suturing. In group 3، immediately after wound closure، 1. 5 g of TXA in 100 cc of saline was injected into the knee through the drain. Group 4 (control group) received no TXA، but the drain was clamped completely for an hour. The amount of blood loss and transfusion، and changes in hemoglobin levels were documented accordingly. The mean post-operative blood loss in the groups 1 to 4 were respectively 476. 8±114. 8، 743. 2±116. 5، 173. 9±60. 5، and 860. 5±152. 2 ml (p<. 001). The post-operative hemoglobin decreased by 2. 63±0. 9، 4. 2±1، 3. 9±1. 1 and 4. 5±1 mg/dl in the groups 1 to 4، respectively (p<. 001). Intravenous injection of TXA is more effective than intra-articular administration، in reducing the post-operative hemoglobin drop.