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Topical tranexamic acid may reduce blood loss after TKA
Wong J. J Bone Joint Surg. 2010;92:2503-2513. doi:10.2106/JBJS.I.01518.
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Applying tranexamic acid directly on the surgical wound reduced postoperative bleeding after total knee arthroplasty, according to results of a randomized controlled trial.
Jean Wong, MD, FRCPC, and colleagues at the University of Toronto, included 124 patients undergoing primary unilateral total knee arthroplasty in a prospective, double-blind, placebo-controlled trial. Patients were randomized to receive either 1.5 g or 3 g of tranexamic acid in 100 mL of normal saline solution or an equivalent volume of placebo (normal saline solution). Surgeons applied the solution to the joint for 5 minutes near the end of the procedure.
For the primary outcome, the investigators measured the difference in blood loss between the preoperative hemoglobin level and the corresponding lowest postoperative value or hemoglobin level prior to transfusion. To assess safety, the investigators performed a Doppler ultrasound on all patients and measured plasma levels of tranexamic acid 1 hour after tourniquet release.
Twenty-five patients withdrew from the study, leaving 99 patients in the intention-to-treat analysis.
The results showed that postoperative blood loss was reduced in the 1.5 g tranexamic acid group (1295 mL) and the 3 g tranexamic acid group (1208 mL) vs. the placebo group (1610 mL).
Postoperative hemoglobin levels were higher in the 1.5 g tranexamic acid group (10.0 g/dL) and the 3 g group (10.1 g/dL) compared to placebo (8.6 g/dL).
The investigators saw no differences in the deep vein thrombosis or pulmonary embolism rates. They recorded only minimal systemic absorption of tranexamic acid.