Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2014

01-08-2014 | Knee

Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review

Authors: Tae Kyun Kim, Chong Bum Chang, In Jun Koh

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2014

Login to get access

Abstract

Purpose

This systematic review was undertaken to answer three specific questions relating to the clinical values of tranexamic acid (TNA) in total knee arthroplasty (TKA): (1) Whether there are differences in blood-saving effects between the systemic and topical administrations; (2) Whether blood-saving effects of TNA differ by doses and timings of administration; and (3) Whether the use of TNA is safe at all reported doses, timings, and routes of administration with respect to the incidences of symptomatic deep-vein thrombosis (DVT) and pulmonary embolism (PE).

Methods

A systematic review was carried out with 28 randomised controlled trials to evaluate the efficacy and safety of TNA use in TKA identified from the literature.

Results

Both systemic and topical administrations reduced blood loss after TKA, but transfusion reducing effects varied in studies whether systemic or topical administrations. The effects of TNA were influenced by doses and timings of administration. No increased incidences of symptomatic DVT and PE were found for all reported doses, timings, and routes of TNA administration.

Conclusion

Surgeons can consider incorporating the use of TNA to their blood-saving protocols in TKA without serious concern of adverse events but need to adopt optimal doses, timings, and routes of TNA administrations.

Level of evidence

Systematic review of randomised controlled trials, Level I.
Literature
1.
Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM (2011) Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br 93:1577–1585PubMedCrossRef
2.
Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F (2008) Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion 48:519–525PubMedCrossRef
3.
Benoni G, Fredin H (1996) Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 78:434–440PubMed
4.
Benoni G, Lethagen S, Fredin H (1997) The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty. Thromb Res 85:195–206PubMedCrossRef
5.
Boettner F, Sculco P, Altneu E, Capar B, Sculco TP (2009) Efficiency of autologous blood donation in combination with a cell saver in bilateral total knee arthroplasty. HSS J 5:45–48PubMedCentralPubMedCrossRef
6.
Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE (2004) Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 19:281–287PubMedCrossRef
7.
Borghi B, Casati A (2000) Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. The Rizzoli Study Group on Orthopaedic Anaesthesia. Eur J Anaesthesiol 17:411–417PubMedCrossRef
8.
Callaghan JJ, O’Rourke MR, Liu SS (2005) Blood management: issues and options. J Arthroplasty 20:51–54PubMedCrossRef
9.
Camarasa MA, Olle G, Serra-Prat M, Martin A, Sanchez M, Ricos P, Perez A, Opisso L (2006) Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth 96:576–582PubMedCrossRef
10.
Charoencholvanich K, Siriwattanasakul P (2011) Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res 469:2874–2880PubMedCentralPubMedCrossRef
11.
Coffey A, Pittmam J, Halbrook H, Fehrenbacher J, Beckman D, Hormuth D (1995) The use of tranexamic acid to reduce postoperative bleeding following cardiac surgery: a double-blind randomized trial. Am Surg 61:566–568PubMed
12.
Crowther M, Lim W, Crowther MA (2010) Systematic review and meta-analysis methodology. Blood 116:3140–3146PubMedCrossRef
13.
Dramis A, Plewes J (2006) Autologous blood transfusion after primary unilateral total knee replacement surgery. Acta Orthop Belg 72:15–17PubMed
14.
Dunn CJ, Goa KL (1999) Tranexamic acid: a review of its use in surgery and other indications. Drugs 57:1005–1032PubMedCrossRef
15.
Ellis MH, Fredman B, Zohar E, Ifrach N, Jedeikin R (2001) The effect of tourniquet application, tranexamic acid, and desmopressin on the procoagulant and fibrinolytic systems during total knee replacement. J Clin Anesth 13:509–513PubMedCrossRef
16.
Engel JM, Hohaus T, Ruwoldt R, Menges T, Jurgensen I, Hempelmann G (2001) Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or aprotinin. Anesth Analg 92:775–780PubMedCrossRef
17.
Good L, Peterson E, Lisander B (2003) Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 90:596–599PubMedCrossRef
18.
Hiippala S, Strid L, Wennerstrand M, Arvela V, Mantyla S, Ylinen J, Niemela H (1995) Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth 74:534–537PubMedCrossRef
19.
Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemela HM, Mantyla SK, Kuisma RP, Ylinen JE (1997) Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 84:839–844PubMed
20.
Ido K, Neo M, Asada Y, Kondo K, Morita T, Sakamoto T, Hayashi R, Kuriyama S (2000) Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties. Arch Orthop Trauma Surg 120:518–520PubMedCrossRef
21.
Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, Kubo S, Matsumoto T, Matsushita T, Chin T, Iguchi T, Kurosaka M, Kuroda R (2011) Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 35:1639–1645PubMedCentralPubMedCrossRef
22.
Jansen AJ, Andreica S, Claeys M, D’Haese J, Camu F, Jochmans K (1999) Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth 83:596–601PubMedCrossRef
23.
Juelsgaard P, Larsen UT, Sorensen JV, Madsen F, Soballe K (2001) Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Reg Anesth Pain Med 26:105–110PubMed
24.
Kakar PN, Gupta N, Govil P, Shah V (2009) Efficacy and safety of tranexamic acid in control of bleeding following TKR: a randomized clinical trial. Indian J Anaesth 53:667–671PubMedCentralPubMed
25.
Kiss H, Raffl M, Neumann D, Hutter J, Dorn U (2005) Epinephrine-augmented hypotensive epidural anesthesia replaces tourniquet use in total knee replacement. Clin Orthop Relat Res 436:184–189PubMedCrossRef
26.
Lin PC, Hsu CH, Chen WS, Wang JW (2011) Does tranexamic acid save blood in minimally invasive total knee arthroplasty? Clin Orthop Relat Res 469:1995–2002PubMedCentralPubMedCrossRef
27.
MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT (2011) Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty 26:24–28PubMedCrossRef
28.
Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR (2012) Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 470:2605–2612PubMedCentralPubMedCrossRef
29.
30.
McConnell JS, Shewale S, Munro NA, Shah K, Deakin AH, Kinninmonth AW (2012) Reducing blood loss in primary knee arthroplasty: a prospective randomised controlled trial of tranexamic acid and fibrin spray. Knee 19:295–298PubMedCrossRef
31.
Molloy DO, Archbold HA, Ogonda L, McConway J, Wilson RK, Beverland DE (2007) Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial. J Bone Joint Surg Br 89:306–309PubMedCrossRef
32.
Onodera T, Majima T, Sawaguchi N, Kasahara Y, Ishigaki T, Minami A (2012) Risk of deep venous thrombosis in drain clamping with tranexamic acid and carbazochrome sodium sulfonate hydrate in total knee arthroplasty. J Arthroplasty 27:105–108PubMedCrossRef
33.
Orpen NM, Little C, Walker G, Crawfurd EJ (2006) Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee 13:106–110PubMedCrossRef
34.
Rousou JA, Engelman RM, Flack JE 3rd, Deaton DW, Owen SG (1995) Tranexamic acid significantly reduces blood loss associated with coronary revascularization. Ann Thorac Surg 59:671–675PubMedCrossRef
35.
Roy SP, Tanki UF, Dutta A, Jain SK, Nagi ON (2012) Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:2494–2501PubMedCrossRef
36.
Royston D (1995) Blood-sparing drugs: aprotinin, tranexamic acid, and epsilon-aminocaproic acid. Int Anesthesiol Clin 33:155–179PubMedCrossRef
37.
Sekhavat L, Tabatabaii A, Dalili M, Farajkhoda T, Tafti AD (2009) Efficacy of tranexamic acid in reducing blood loss after cesarean section. J Matern Fetal Neonatal Med 22:72–75PubMedCrossRef
38.
Seo JG, Moon YW, Park SH, Kim SM, Ko KR (2012) The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-012-2079-2
39.
Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S (2001) Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 83:702–705PubMedCrossRef
40.
Veien M, Sorensen JV, Madsen F, Juelsgaard P (2002) Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study. Acta Anaesthesiol Scand 46:1206–1211PubMedCrossRef
41.
Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, Syed KA, Muhammad Ovais Hasan S, De Silva Y, Chung F (2010) Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 92:2503–2513PubMed
42.
Yang ZG, Chen WP, Wu LD (2012) Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 94:1153–1159PubMedCrossRef
43.
Zhang H, Chen J, Chen F, Que W (2012) The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 20:1742–1752PubMedCrossRef
44.
Zohar E, Ellis M, Ifrach N, Stern A, Sapir O, Fredman B (2004) The postoperative blood-sparing efficacy of oral versus intravenous tranexamic acid after total knee replacement. Anesth Analg 99:1679–1683PubMedCrossRef
45.
Zohar E, Fredman B, Ellis M, Luban I, Stern A, Jedeikin R (1999) A comparative study of the postoperative allogeneic blood-sparing effect of tranexamic acid versus acute normovolemic hemodilution after total knee replacement. Anesth Analg 89:1382–1387PubMed
Metadata
Title
Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review
Authors
Tae Kyun Kim
Chong Bum Chang
In Jun Koh
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2487-y

Other articles of this Issue 8/2014

Knee Surgery, Sports Traumatology, Arthroscopy 8/2014 Go to the issue

Knee

Comparison of custom to standard TKA instrumentation with computed tomography

Knee

Difference in knee rotation between total and unicompartmental knee arthroplasties during stair climbing

Editorial

Michael T. Hirschmann, MD—Associate Editor

Knee

Periarticular multimodal drug injection in total knee arthroplasty

Knee

Does total knee arthroplasty modify flexion axis of the knee?

Knee

Repeatability and accuracy of a non-invasive method of measuring internal and external rotation of the tibia