Research Article
Year 2025,
Volume: 15 Issue: 1, 32 - 38, 30.04.2025
Abstract
References
- 1. Karahan M, Acar E, Serarslan U, Gültekin A. Medial pivot total knee arthroplasty: Mid-term results. Acta Orthop Belg. 2023;89:97–102.
- 2. Fan D, Ma J, Liu X, Zhang L. Peri-articular administration of tranexamic acid is an alternative route in total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):211.
- 3. Sadigursky D, Araujo LM, Fernandes RJC. Efficacy of tranexamic acid in reducing blood loss in total knee arthroplasty. Acta Ortop Bras. 2018;26:63–6.
- 4. DeMik DE, Carender CN, Glass NA, Brown TS, Callaghan JJ, Bedard NA. Who is still receiving blood transfusions after primary and revision total joint arthroplasty? J Arthroplasty. 2022;37(6s):S63–9.
- 5. Conteduca F, Massai F, Iorio R, Zanzotto E, Luzon D, Ferretti A. Blood loss in computer-assisted mobile bearing total knee arthroplasty. A comparison of computer-assisted surgery with a conventional technique. Int Orthop. 2009;33:1609–13.
- 6. Kumar A. Perioperative management of anemia: limits of blood transfusion and alternatives to it. Cleve Clin J Med. 2009;76Suppl 4:S112–S118.
- 7. Pitta M, Zawadsky M, Verstraete R, Rubinstein A. Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610-patient consecutive case series. Transfusion. 2016;56:466–71.
- 8. Ling T, Zhang L, Huang L. The efficacy and safety of combined administration of intravenous and intra-articular tranexamic acid in total knee arthroplasty: An update meta-analysis. J Clin Pharm Ther. 2022;47(9):1312–1321.
- 9. Wu Y, Yang T, Zeng Y, Li C, Shen B, Pei F. Clamping drainage is unnecessary after minimally invasive total knee arthroplasty in patients with tranexamic acid: A randomized, controlled trial. Medicine (Baltimore) . 2017;96:e5804.
- 10. Migliorini F, Maffulli N, Betsch M, Eschweiler J, Tingart M, Baroncini A. Closed suction drainages in Lower Limb Joint Arthroplasty: A level I evidence based meta-analysis. Surgeon. 2022;20(3):e51–e60.
- 11. Han YH, Huang HT, Pan JK, Zeng LF, Liang GH, Liang HD, et al. 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 (Baltimore) .2018;97(36):e11573.
- 12. Akgül T, Büget M, Salduz A, Edipoğlu İS, Ekinci M, Küçükay S, et al. Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study. Acta Orthop Traumatol Turc. 2016;50:429–31.
- 13. Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011;35:1639–45.
- 14. Chen JY, Chin PL, Moo IH, Pang HN, Tay DK, Chia SL, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial. Knee. 2016;23:152–56.
- 15. 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:e024350.
- 16. Han X, Gong G, Han N, Liu M. Efficacy and safety of oral compared with intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a metaanalysis. BMC Musculoskelet Disord. 2018;19:430.
- 17. Hmidan Simsam M, Delorme L, Grimm D, Priestap F, Bohnert S, Descoteaux M, et al. Efficacy of high dose tranexamic acid (TXA) for hemorrhage: A systematic review and meta-analysis. Injury. 2023;54:857–70.
- 18. Fígar A, Mc Loughlin S, Slullitel PA, Scordo W, Buttaro MA. Influence of single-dose intravenous tranexamic acid on total hip replacement: A study on transfusions, collateral complications, and readmissions. Einfluss einer intravenösen Einzelgabe von Tranexamsäure auf die Implantation einer Hüfttotalendoprothese: Eine Studie zu Transfusionen, kolateralen Komplikationen und Rehospitalisierungen. Orthopade. 2017;46:359–65.
- 19. Kang BX, Li YL, Xu H, Gao CX, Zhong S, Zhang J, et al. Effect of Multiple Doses of Intravenous Tranexamic Acid on Perioperative Blood Loss in Total Knee Arthroplasty: A Randomized Controlled Study. Orthop Surg. 2021;13:126–33.
- 20. Sershon RA, Fillingham YA, Abdel MP, Malkani AL, Schwarzkopf R, Padgett DE, et al. The Optimal Dosing Regimen for Tranexamic Acid in Revision Total Hip Arthroplasty: A Multicenter Randomized Clinical Trial. J Bone Joint Surg Am. 2020;102:1883–90.
- 21. Yang YZ, Cheng QH, Zhang AR, Yang X, Zhang ZZ, Guo HZ. Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18:593.
- 22. Chareancholvanich K, Siriwattanasakul P, Narkbunnam R, Pornrattanamaneewong C. Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2012;20;13:124.
- 23. Kiely N, Hockings M, Gambhir A. Does temporary clamping of drains following knee arthroplasty reduce blood loss? A randomised controlled trial. Knee. 2001;8:325–27.
- 24. Sa-Ngasoongsong P, Wongsak S, Chanplakorn P, Woratanarat P, Wechmongkolgorn S, Wibulpolprasert B, et al. Efficacy of lowdose intra-articular tranexamic acid in total knee replacement;a prospective triple-blinded randomized controlled trial. BMC Musculoskelet Disord. 2013;14:340.
- 25. Wilde JM, Copp SN, McCauley JC, Bugbee WD. One dose of intravenous tranexamic acid is equivalent to two doses in total hip and knee arthro plasty. J Bone Joint Surg Am. 2018;100:1104–9.
- 26. Charette RS, Bernstein JA, Sloan M, Nchako CM, Kamath AF, Nelson CL. One versus two doses of intravenous tranexamic acid in total knee arthroplasty. J Knee Surg. 2021;34:749–54.
- 27. Golz AG, Yee HK, Davis BJ, Adams WH, Brown NM. One dose versus two doses of intravenous tranexamic acid in total joint arthroplasty. J Am Acad Orthop Surg. 2021;29:e555–62.
Tranexamic Acid in Total Knee Arthroplasty: A Comprehensive Examination of Double-Dose Strategies for Hemostasis
Abstract
Aim: The current study aimed to evaluate the impact of administering tranexamic acid (TXA) through intravenous (IV) or intraarticular (IA) routes, in double doses, in conjunction with postoperative drain clamping (DC), on postoperative bleeding, transfusion requirements, and thromboembolic complications in patients undergoing total knee arthroplasty (TKA).
Material and Methods: A retrospective review of 96 patients undergoing unilateral primary TKA for gonarthrosis between 2021 and 2022 was conducted. Patients received either double-dose IV TXA (n=52), double-dose IA TXA (n=26), or no TXA (n=18) along with postoperative DC. Various parameters were compared among groups, including preoperative and postoperative hemoglobin (Hb) levels, blood transfusion requirements, and length of hospital stay (LOS).
Results: Both IV and IA double-dose TXA significantly reduced postoperative bleeding compared to no TXA administration. The need for blood transfusion was lowest in the double-dose IV TXA group. No significant differences were observed in thromboembolic complications among the groups. Length of hospital stay (LOS) was significantly shorter in the TXA groups compared to the no TXA group.
Conclusions: Administration of double-dose TXA, either IV or IA and postoperative DC effectively reduced postoperative bleeding in TKA patients. Double-dose IV TXA demonstrated the lowest transfusion rates, suggesting a potential advantage in reducing transfusion requirements. Both IV and IA TXA administrations were safe and efficacious, with no significant increase in thromboembolic complications, emphasizing their overall safety profile in TKA patients.
References
- 1. Karahan M, Acar E, Serarslan U, Gültekin A. Medial pivot total knee arthroplasty: Mid-term results. Acta Orthop Belg. 2023;89:97–102.
- 2. Fan D, Ma J, Liu X, Zhang L. Peri-articular administration of tranexamic acid is an alternative route in total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):211.
- 3. Sadigursky D, Araujo LM, Fernandes RJC. Efficacy of tranexamic acid in reducing blood loss in total knee arthroplasty. Acta Ortop Bras. 2018;26:63–6.
- 4. DeMik DE, Carender CN, Glass NA, Brown TS, Callaghan JJ, Bedard NA. Who is still receiving blood transfusions after primary and revision total joint arthroplasty? J Arthroplasty. 2022;37(6s):S63–9.
- 5. Conteduca F, Massai F, Iorio R, Zanzotto E, Luzon D, Ferretti A. Blood loss in computer-assisted mobile bearing total knee arthroplasty. A comparison of computer-assisted surgery with a conventional technique. Int Orthop. 2009;33:1609–13.
- 6. Kumar A. Perioperative management of anemia: limits of blood transfusion and alternatives to it. Cleve Clin J Med. 2009;76Suppl 4:S112–S118.
- 7. Pitta M, Zawadsky M, Verstraete R, Rubinstein A. Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610-patient consecutive case series. Transfusion. 2016;56:466–71.
- 8. Ling T, Zhang L, Huang L. The efficacy and safety of combined administration of intravenous and intra-articular tranexamic acid in total knee arthroplasty: An update meta-analysis. J Clin Pharm Ther. 2022;47(9):1312–1321.
- 9. Wu Y, Yang T, Zeng Y, Li C, Shen B, Pei F. Clamping drainage is unnecessary after minimally invasive total knee arthroplasty in patients with tranexamic acid: A randomized, controlled trial. Medicine (Baltimore) . 2017;96:e5804.
- 10. Migliorini F, Maffulli N, Betsch M, Eschweiler J, Tingart M, Baroncini A. Closed suction drainages in Lower Limb Joint Arthroplasty: A level I evidence based meta-analysis. Surgeon. 2022;20(3):e51–e60.
- 11. Han YH, Huang HT, Pan JK, Zeng LF, Liang GH, Liang HD, et al. 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 (Baltimore) .2018;97(36):e11573.
- 12. Akgül T, Büget M, Salduz A, Edipoğlu İS, Ekinci M, Küçükay S, et al. Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study. Acta Orthop Traumatol Turc. 2016;50:429–31.
- 13. Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011;35:1639–45.
- 14. Chen JY, Chin PL, Moo IH, Pang HN, Tay DK, Chia SL, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial. Knee. 2016;23:152–56.
- 15. 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:e024350.
- 16. Han X, Gong G, Han N, Liu M. Efficacy and safety of oral compared with intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a metaanalysis. BMC Musculoskelet Disord. 2018;19:430.
- 17. Hmidan Simsam M, Delorme L, Grimm D, Priestap F, Bohnert S, Descoteaux M, et al. Efficacy of high dose tranexamic acid (TXA) for hemorrhage: A systematic review and meta-analysis. Injury. 2023;54:857–70.
- 18. Fígar A, Mc Loughlin S, Slullitel PA, Scordo W, Buttaro MA. Influence of single-dose intravenous tranexamic acid on total hip replacement: A study on transfusions, collateral complications, and readmissions. Einfluss einer intravenösen Einzelgabe von Tranexamsäure auf die Implantation einer Hüfttotalendoprothese: Eine Studie zu Transfusionen, kolateralen Komplikationen und Rehospitalisierungen. Orthopade. 2017;46:359–65.
- 19. Kang BX, Li YL, Xu H, Gao CX, Zhong S, Zhang J, et al. Effect of Multiple Doses of Intravenous Tranexamic Acid on Perioperative Blood Loss in Total Knee Arthroplasty: A Randomized Controlled Study. Orthop Surg. 2021;13:126–33.
- 20. Sershon RA, Fillingham YA, Abdel MP, Malkani AL, Schwarzkopf R, Padgett DE, et al. The Optimal Dosing Regimen for Tranexamic Acid in Revision Total Hip Arthroplasty: A Multicenter Randomized Clinical Trial. J Bone Joint Surg Am. 2020;102:1883–90.
- 21. Yang YZ, Cheng QH, Zhang AR, Yang X, Zhang ZZ, Guo HZ. Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18:593.
- 22. Chareancholvanich K, Siriwattanasakul P, Narkbunnam R, Pornrattanamaneewong C. Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2012;20;13:124.
- 23. Kiely N, Hockings M, Gambhir A. Does temporary clamping of drains following knee arthroplasty reduce blood loss? A randomised controlled trial. Knee. 2001;8:325–27.
- 24. Sa-Ngasoongsong P, Wongsak S, Chanplakorn P, Woratanarat P, Wechmongkolgorn S, Wibulpolprasert B, et al. Efficacy of lowdose intra-articular tranexamic acid in total knee replacement;a prospective triple-blinded randomized controlled trial. BMC Musculoskelet Disord. 2013;14:340.
- 25. Wilde JM, Copp SN, McCauley JC, Bugbee WD. One dose of intravenous tranexamic acid is equivalent to two doses in total hip and knee arthro plasty. J Bone Joint Surg Am. 2018;100:1104–9.
- 26. Charette RS, Bernstein JA, Sloan M, Nchako CM, Kamath AF, Nelson CL. One versus two doses of intravenous tranexamic acid in total knee arthroplasty. J Knee Surg. 2021;34:749–54.
- 27. Golz AG, Yee HK, Davis BJ, Adams WH, Brown NM. One dose versus two doses of intravenous tranexamic acid in total joint arthroplasty. J Am Acad Orthop Surg. 2021;29:e555–62.
There are 27 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Research Article |
| Authors | |
| Publication Date | April 30, 2025 |
| Submission Date | August 25, 2024 |
| Acceptance Date | February 11, 2025 |
| Published in Issue | Year 2025 Volume: 15 Issue: 1 |
