Optimal dose of topical tranexamic acid considering efficacy and safety in total knee arthroplasty: a randomized control
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Optimal dose of topical tranexamic acid considering efficacy and safety in total knee arthroplasty: a randomized controlled study Jong‑Keun Kim1 · Jae‑Young Park2 · Do Yoon Lee2 · Du Hyun Ro2 · Hyuk‑Soo Han2 · Myung Chul Lee2 Received: 27 May 2020 / Accepted: 14 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose This study aimed to evaluate the optimal dosage of topical tranexamic acid (TXA) considering the efficacy and safety for controlling bleeding after total knee arthroplasty (TKA). Methods This prospective randomized double-blinded placebo-controlled comparative study included 325 patients scheduled to undergo TKA, who were randomly assigned to five groups based on the topical TXA injection (n = 65 per group): control; group 1, 0.5 g TXA; group 2, 1.0 g TXA; group 3, 2.0 g TXA; and group 4, 3.0 g TXA. The primary outcome was decrease in postoperative hemoglobin levels. The secondary outcomes were blood loss calculated using Good’s method, drainage volume, frequency of transfusion, and range of motion (ROM). Plasma TXA levels and complications were also evaluated. Results Significant differences were noted in the decrease in hemoglobin levels between the control group and groups 2 (p = 0.0027), 3 (p = 0.005), and 4 (p = 0.001). No significant differences were shown among the experimental groups. Significant differences in total blood loss and frequency of transfusion were noted between the control group and groups 2 (p = 0.004, 0.002, respectively), 3 (p = 0.007, 0.001, respectively), and 4 (p = 0.001, 0.009, respectively) without showing significant differences among the experimental groups. With respect to drainage volume, no significant differences were observed among the groups. The serum TXA levels increased proportionally with the applied dose of topical TXA immediately and at 3 and 6 h postoperatively. Symptomatic deep vein thrombosis or pulmonary embolism was not observed in any group. Other complications related to TXA administration were not detected. Conclusion Topical application of 1.0 g or more of TXA shows significant bleeding control without a dose–response relationship. Blood TXA levels increase with the TXA dose following topical TXA application. Therefore, to prevent overdosing and reduce potential complications with ensuring the effectiveness, 1.0 g of TXA is recommended as a topical application. Level of evidence I. Keywords Tranexamic acid · Total knee arthroplasty · Topical injection · Blood loss · Hemoglobin level · Blood level
Introduction Total knee arthroplasty (TKA) induces significant blood loss, leading to requirement of blood transfusion. Various methods have been attempted to prevent bleeding, including auto-transfusion, suction drain tube locking, fibrin attachment, and tranexamic acid (TXA) administration [10–12, 22]. * Myung Chul Lee [email protected] 1
Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, South Korea
Department of Orthopedic Surgery, Seoul National University College
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