Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022, 166(1):68-76 | DOI: 10.5507/bp.2020.045

Combined and intravenous administration of TXA reduces blood loss more than topical administration in primary total knee arthroplasty: A randomized clinical trial

Jiri Lostaka, Jiri Galloa, Lubos Balaza, Jana Zapletalovab
a Department of Orthopaedics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
b Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

Aim: To determine the most effective administration of tranexamic acid (TXA) in patients with primary total knee arthroplasty (TKA). Material and Method. We enrolled a total of 400 patients (154 men and 346 women) in this randomized trial (4 groups, each of 100 patients). The first group (IV1) had a single intravenous dose (15 mg TXA/kg) prior to skin incision. Group 2 (IV2) had TXA in 2 intravenous doses (15 mg TXA/kg): prior to skin incision and 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 mL of saline irrigated topically at the end of the surgery. The fourth group (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient.

Results: The amount of TBL was significantly lower in IV1, IV2 and COMB regimens compared to the TOP (P<0.0001). The lowest decrease in haemoglobin within 12 hours after surgery was observed in intravenous regimens (P=0.045). A significant difference in haemoglobin decrease on day 1 after the surgery was demonstrated in the COMB and intravenous regimens (P=0.011).

Conclusion: In primary TKA, it is preferable to administer TXA intravenously in two doses or in a combined regimen. Simple topical administration of TXA was not as effective and is indicated only in cases where systemic administration of TXA is contraindicated. No substantial complications occurred in either group of patients.

Keywords: total knee arthroplasty, tranexamic acid, topical administration, intravenous administration, combined administration, randomized clinical trial

Received: April 3, 2020; Revised: September 27, 2020; Accepted: September 29, 2020; Prepublished online: October 15, 2020; Published: March 1, 2022  Show citation

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Lostak, J., Gallo, J., Balaz, L., & Zapletalova, J. (2022). Combined and intravenous administration of TXA reduces blood loss more than topical administration in primary total knee arthroplasty: A randomized clinical trial. Biomedical papers, 166(1), 68-76. doi: 10.5507/bp.2020.045
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    References

    1. Lee SY, Chong S, Balasubramanian D, Na YG, Kim TK. What is the Ideal Route of Administration of Tranexamic Acid in TKA? A Randomized Controlled Trial. Clini Orthop Relat Res 2017;475(8):1987-96. Go to original source... Go to PubMed...
    2. Zhang S, Wang C, Shi L, Xue Q. Multi-route applications of tranexamic acid to reduce blood loss after total knee arthroplasty: a randomized controlled trial. Medicine 2019;98(30):e16570. Go to original source... Go to PubMed...
    3. Xie J, Hu Q, Huang Q, Ma J, Lei Y, Pei F. Comparison of intravenous versus topical tranexamic acid in primary total hip and knee arthroplasty: An updated meta-analysis. Thromb Res 2017;153:28-36. Go to original source... Go to PubMed...
    4. Xiong H, Liu Y, Zeng Y, Wu Y, Shen B. The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC musculoskeletal disorders 2018;19(1):321. Go to original source... Go to PubMed...
    5. Kim YT, Kang MW, Lee JK, Lee YM, Kim JI. Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis. BMC musculoskeletal disorders 2018;19(1):227. Go to original source... Go to PubMed...
    6. Lostak J, Gallo J, Vecera M, Spicka J, Langova K. [Local Application of Tranexamic Acid in Total Hip Arthroplasty Decreases Blood Loss and Consumption of Blood Transfusion]. Acta Chir Orthop Traumatol Cech 2017;84(4):254-62. Go to PubMed...
    7. Han YH, Huang HT, Pan JK, Zeng LF, Liang GH, Liang HD, Yang WY, Guo D, Liu J. Is the combined application of both drain-clamping and tranexamic acid superior to the single use of either application in patients with total-knee arthroplasty?: A meta-analysis of randomized controlled trials. Medicine 2018;97(36):e11573. Go to original source... Go to PubMed...
    8. Zhang H, He G, Zhang C, Xu B, Wang X, Zhang C. Is combined topical and intravenous tranexamic acid superior to intravenous tranexamic acid alone for controlling blood loss after total hip arthroplasty?: A meta-analysis. Medicine 2017;96(21):e6916. Go to original source... Go to PubMed...
    9. Yuan X, Wang J, Wang Q, Zhang X. Synergistic effects of intravenous and intra-articular tranexamic acid on reducing hemoglobin loss in revision total knee arthroplasty: a prospective, randomized, controlled study. Transfusion 2018;58(4):982-8. Go to original source... Go to PubMed...
    10. Lostak J, Gallo J, Slavik L, Zapletalova J, Balaz L. Monitoring of fibrinolytic system activity with plasminogen, D-dimers and FDP in primary total knee arthroplasty (TKA) after topical, intravenous or combined administration of tranexamic acid. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020,164(2):168-76 doi: 10.5507/bp.2019.034 Go to original source... Go to PubMed...
    11. Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Shores P, Mullen K, Bini SA, Clarke HD, Schemitsch E, Johnson RL, Memtsoudis SG, Sayeed SA, Sah AP, Della Valle CJ. The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis. J Arthroplasty 2018;33(10):3090-8.e1. Go to original source... Go to PubMed...
    12. McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 2002(403):8-15. Go to original source...
    13. Shen HL, Li Z, Feng ML, Cao GL. Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis. Chin Med J (Engl) 2011;124(11):1653-6. Go to PubMed...
    14. Tzatzairis T, Drosos GI, Vogiatzaki T, Tilkeridis K, Ververidis A, Kazakos K. Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study. Arch Orthop Trauma Surg 2019;139(6):859-68. Go to original source... Go to PubMed...
    15. Pinsornsak P, Rojanavijitkul S, Chumchuen S. Peri-articular tranexamic acid injection in total knee arthroplasty: a randomized controlled trial. BMC Musculoskelet Disord 2016;17:313. Go to original source... Go to PubMed...
    16. Burleson A, Guler N, Banos A, Syed D, Wanderling C, Hoppensteadt D, Rees H, Fareed J, Hopkinson W. Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients. Clin Appl Thromb Hemost 2016;22(3):274-9. Go to original source... Go to PubMed...
    17. Nielsen CS, Jans O, Orsnes T, Foss NB, Troelsen A, Husted H. Combined Intra-Articular and Intravenous Tranexamic Acid Reduces Blood Loss in Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial. J Bone Joint Surg Am 2016;98(10):835-41. Go to original source... Go to PubMed...
    18. Sun Q, Li J, Chen J, Zheng C, Liu C, Jia Y. Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials. BMJ open 2019;9(1):e024350. Go to original source... Go to PubMed...
    19. Jain NP, Nisthane PP, Shah NA. Combined Administration of Systemic and Topical Tranexamic Acid for Total Knee Arthroplasty: Can It Be a Better Regimen and Yet Safe? A Randomized Controlled Trial. J Arthroplasty 2016;31(2):542-7. Go to original source... Go to PubMed...
    20. Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br 2009;91(6):776-83. Go to original source... Go to PubMed...

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