Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2024; 91(3):151-155 | DOI: 10.55095/achot2024/019

Intraarticular TXA Administration with Appropriate Timing of Clamping and Appropriate Dose is More Effective Than IV Administration

F. EMRE¹, E. ULUYARDIMCI², M. TAHTA³, Ç. IŞIK⁴

¹ VM Medicalpark Ankara Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey

² Yildirim Beyazit University, Department of Orthopedics and Traumatology, Ankara, Turkey

³ Egepol Surgery Hospital, Department of Orthopedics and Traumatology, İzmir, Turkey

⁴ Arel University, Memorial Ataşehir Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey

Purpose of the study
Our aim was to compare the effects of intraarticular and intravenous (IV) tranexemic acid (TXA) application on bleeding and complication rates in patients who underwent total knee arthroplasty (TKA).
Material and methods
Between 2017 and 2021, 406 patients who underwent TKA with 2 g of IV TXA and retrograde 1.5 g of TXA applied through the drain were included in the study. Of the patients, 206 were in the IV TXA group. Preoperative and postoperative hemoglobin levels, drain output, BMI, ASA score, blood loss, and the number of transfused patients were recorded. Complications such as symptomatic venous thromboembolism were also recorded.
Results
There was no significant difference between the two groups in terms of age, sex, American Society of Anesthesiologists (ASA) score, or BMI (p = 0.68, 0.54, 0.28, 0.45). Total drain output and blood loss were significantly higher in the IV TXA group than in the intraarticular TXA group (p < 0.0001, p < 0.0001). Eighteen patients in the IV TXA group and 1 patient in the intraarticular TXA group received a blood transfusion (p < 0.0001). There was no difference between the two groups in terms of preoperative hemoglobin or platelet count (p = 0.24). However, postoperative hemoglobin level was higher in the patients who received intraarticular TXA (p=0.0005). More thromboembolism events were seen in the IV TXA group (p < 0.0001).
Conclusions
Intraarticular TXA application reduces blood loss more than IV application, reduces the blood transfusion rate, and causes fewer complications.

Keywords: tranexemic acid, total knee arthroplasty, intraarticular injection, blood loss, blood transfusion.

Received: March 23, 2024; Revised: March 23, 2024; Accepted: July 13, 2024; Published: July 19, 2024  Show citation