Efficacy And Safety Of Intravenous And Intra-Articular Sequential Application Of Tranexamic Acid During Total Knee Arthroplasty

Objective:To assess the impact of different administration methods of tranexamic acid on total blood loss volume following primary unilateral total knee arthroplasty. Methods:70 patients receiving unilateral total knee arthroplasty were randomly divided into 3 groups. Tranexamic acid was given intra-articularly at the end of the operation in group A (24 patients) and intravenously as well as intra-articularly in group B (23 patients). Meanwhile, intra-articular injection of saline solution has been performed for group C (23 patients). Total blood loss volume, transfusion rate, drainage volume, lower limb diameter (thigh and calf girth), D-dimer as well as thrombelastogram of 3 groups were measured and compared. Results:Total blood loss volumes were 541±210 ml,456±216 ml and 731±179 ml for three groups, respectively; Drainage volumes were 104±44 ml,98 ml±48 and 160±60 ml for each group. For both index, group C were significantly larger than the other two groups (P<0.05), while no significant difference was demonstrated among group A and B (p>0.05). For other parameters like transfusion rate, lower limb diameter and deep venous thrombosis rate, no difference was detected among those 3 groups (p>0.05). Conclusions:Sequential application of intra-articular and intravenous tranexamic acid could reduce, though not significantly, blood loss volume and drainage volume than intra-articular injection alone. No significant difference has been found in terms of transfusion rate, lower limb diameter, and deep venous thrombosis rate following two different application methods.