Comparison of Efficacy & Safety Between Intravenous and Intraarticular Tranexamic Acid in Reducing Blood Loss after Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) is associated with significant postoperative blood loss necessitating blood transfusion. Tranexamic acid is an antifibrinolytic drug that has shown good efficacy in reducing this postoperative morbidity. Although, the most commonly used route of administration is intravenous; the optimal route of administration has not been agreed upon.

AIM: The aim of this study was to evaluate and compare the efficacy and safety of intravenous and intra-articular administration of tranexamic acid in reducing blood loss following TKA.

METHOD: The study was a prospective, interventional; randomized controlled study involving 63 patients who underwent unilateral uncomplicated TKA for severe osteoarthritis of the knee at the National Orthopaedic Hospital, Dala – Kano, Nigeria. The patients were randomized into 3 groups using online random team generator; (1) Intravenous group, (2) Intraarticular group and (3) Control group.

RESULTS: The postoperative blood loss was significantly greater in the control group than in intravenous and intraarticular groups (p = 0.02). Also, the postoperative fall in Hb level and the need for blood transfusion were significantly higher in the control group than in intravenous and intraarticular groups (0.00). However, Intravenous and Intraarticular groups did not differ significantly in terms of the measured variables. There was no significant difference between the preoperative and postoperative platelet counts (p = 0.81), INR (p = 0.21) and serum creatinine (p = 0.39) in all the three study groups.

CONCLUSION: Intravenous and intraarticular tranexamic acid were equally effective and safe for reducing blood loss after TKA.