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Archives of Orthopaedic and Trauma Surgery

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01-07-2015 | Knee Arthroplasty

Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial

Authors: X Aguilera, M. J. Martínez-Zapata, P. Hinarejos, M. Jordán, J. Leal, J. C. González, J. C. Monllau, F. Celaya, A. Rodríguez-Arias, J. A. Fernández, X. Pelfort, L. l. Puig-Verdie

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2015

Abstract

Introduction

Tranexamic acid (TXA) is becoming widely used in orthopedic surgery to reduce blood loss and transfusion requirements, but consensus is lacking regarding the optimal route and dose of administration. The aim of this study was to compare the efficacy and safety of topical and intravenous routes of TXA with routine hemostasis in patients undergoing primary total knee arthroplasty (TKA).

Materials and methods

We performed a randomized, multicenter, parallel, open-label clinical trial in adult patients undergoing primary TKA. Patients were divided into three groups of 50 patients each: Group 1 received 1 g topical TXA, Group 2 received 2 g intravenous TXA, and Group 3 (control group) had routine hemostasis. The primary outcome was total blood loss. Secondary outcomes were hidden blood loss, blood collected in drains, transfusion rate, number of blood units transfused, adverse events, and mortality.

Results

One hundred and fifty patients were included. Total blood loss was 1021.57 (481.09) mL in Group 1, 817.54 (324.82) mL in Group 2 and 1415.72 (595.11) mL in Group 3 (control group). Differences in total blood loss between the TXA groups and the control group were clinically and statistically significant (p < 0.001). In an exploratory analysis differences between the two TXA groups were not statistically significant (p = 0.073) Seventeen patients were transfused. Transfusion requirements were significantly higher in Group 3 (p = 0.005). No significant differences were found between groups regarding adverse events.

Conclusion

We found that 1 g of topical TXA and 2 g of intravenous TXA were both safe strategies and more effective than routine hemostasis to reduce blood loss and transfusion requirements after primary TKA.

Level of evidence

Available only for authorised users

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Title: Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial
Authors: X Aguilera
M. J. Martínez-Zapata
P. Hinarejos
M. Jordán
J. Leal
J. C. González
J. C. Monllau
F. Celaya
A. Rodríguez-Arias
J. A. Fernández
X. Pelfort
L. l. Puig-Verdie
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2232-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

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