Combined Intravenous and Topical Tranexamic Acid Versus Intravenous Administration Alone in Total Knee Arthroplasty: A Comparative Study
Keywords:
tranexamic acid; total knee arthroplasty; blood loss; topical administration; intravenous; transfusion; trauma; hemoglobinAbstract
Background: Postoperative blood loss remains a major concern in total knee arthroplasty (TKA). Tranexamic acid (TXA) reduces bleeding, yet the optimal route of administration is debated. This study compared combined intravenous (IV) plus topical TXA against IV TXA alone. Methods: A comparative study was conducted in the trauma department of the clinics of the Fergana Medical Institute of Public Health on 72 patients undergoing primary unilateral TKA. Thirty-six patients received combined IV and topical TXA and 36 matched controls received IV TXA alone. Total blood loss, hemoglobin decline, transfusion rate, and thromboembolic events were assessed. Results: The combined group showed significantly lower calculated total blood loss (612 vs 884 mL) and smaller hemoglobin decline at postoperative day three. Transfusion requirement fell from 19.4% to 5.6%. Venous thromboembolism rates did not differ. Conclusion: Combined IV and topical TXA offers superior blood conservation over IV TXA alone without added thrombotic risk.
References
[1] S. Sehat, R. L. Newman, and A. J. Hutchinson, “Hidden blood loss in total knee arthroplasty,” J. Bone Joint Surg. Br., vol. 86, no. 4, pp. 561–565, 2004.
[2] M. R. Bong et al., “Risks associated with blood transfusion after total knee arthroplasty,” J. Arthroplasty, vol. 19, no. 3, pp. 281–287, 2004.
[3] B. E. Bierbaum et al., “An analysis of blood management in patients having total hip or knee arthroplasty,” J. Bone Joint Surg. Am., vol. 81, no. 1, pp. 2–10, 1999.
[4] C. J. Dunn and K. L. Goa, “Tranexamic acid: a review of its use in surgery and other indications,” Drugs, vol. 57, no. 6, pp. 1005–1032, 1999.
[5] J. N. Patel et al., “Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty,” J. Arthroplasty, vol. 29, no. 8, pp. 1528–1531, 2014.
[6] J. Xie et al., “Comparison of intravenous versus topical tranexamic acid in primary total hip and knee arthroplasty,” Thromb. Res., vol. 153, pp. 28–36, 2017.
[7] S. Wang, X. Gao, and Y. An, “Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of RCTs,” Int. Orthop., vol. 41, no. 4, pp. 739–748, 2017.
[8] M. Boucher et al., “Topical versus systemic tranexamic acid to reduce blood loss after total knee and hip arthroplasty: a systematic review and meta-analysis,” J. Bone Joint Surg. Am., vol. 107, no. 20, pp. 2300–2309, 2025.
[9] H. Xiong, Y. Liu, Y. Zeng, Y. Wu, and B. Shen, “Efficacy and safety of combined IV and topical tranexamic acid in primary TKA: a meta-analysis,” BMC Musculoskelet. Disord., vol. 19, art. 321, 2018.
[10] P. Zhang and J. Li, “Combined versus single application of tranexamic acid in total knee and hip arthroplasty: a meta-analysis,” Int. J. Surg., vol. 43, pp. 171–180, 2017.
[11] J. Li et al., “Combined IV and topical versus IV tranexamic acid in primary TKA and THA: a meta-analysis of RCTs,” J. Orthop. Surg. Res., vol. 12, art. 22, 2017.
[12] A. M. Abdel et al., “Topical tranexamic acid augmenting intravenous administration in TKA patients at moderate-to-high bleeding risk: an RCT,” J. Arthroplasty, vol. 35, no. 9, pp. 2531–2537, 2020.
[13] A. Klug et al., “Projected volume of primary and revision total knee arthroplasty,” Knee Surg. Sports Traumatol. Arthrosc., vol. 29, pp. 3287–3298, 2021.
[14] X. Liu, J. Liu, and G. Sun, “Combined IV and topical tranexamic acid versus IV alone for blood loss reduction after THA: a meta-analysis,” Int. J. Surg., vol. 41, pp. 34–43, 2017.
[15] W. L. Dai, A. G. Zhou, H. Zhang, and J. Zhang, “Most effective regimen of tranexamic acid for reducing bleeding in primary TKA: a meta-analysis of RCTs,” J. Knee Surg., vol. 31, no. 7, pp. 654–663, 2018.
