Efficacy of topical and intravenous tranexamic acid (txa) in reducing blood loss in primary total knee arthroplasty, a prospective randomized trial

Introduction: Total Knee Arthroplasty (TKA) is a major Orthopaedic operation that involves significant blood loss due to extensive soft tissue release and bone cuts. Fibrinolysis is considered the major cause of postoperative bleeding after TKA surgery, pharmacologic agents such as (Tranexamic Acid) TXA, a plasminogen-activator inhibitor, have been employed to reduce perioperative blood loss and prevent the need for post-operative transfusion. Patients and methods: A prospective randomized study involving 75 patients over a period of 6 month in our arthroplasty unit at a tertiary referral orthopedic hospital. The patients were divided into three groups, 25 patients in each one. GI received 2 gms of intravenous TXA before tourniquet inflation, GII received 3 gms TXA in 100 ml saline intraarticular (topical) after capsular closure, GIII was a control group. The primary outcome measure was perioperative blood loss. Hemoglobin levels at day two postoperative and thromboembolic complications as the secondary outcomes. Results: The mean blood loss was 970.48 ml in the control group, while it was 618.84 ml and 683.84 ml in GI and GII TXA groups respectively, there was significant statistical difference (P<0.05) between GI and GIII; and between GII and GIII. There was no significance difference in blood loss in topical versus intravenous TXA groups. Conclusion: TXA both local and intravenous are effective in reducing blood loss in TKA compared to no TXA usage.