Tranexamic acid in primary total knee arthroplasty: ideal route of administration

Background & Study Aims: Consensus is lacking regarding the optimal route and dose of administration of Tranexamic acid (TXA) so this study was conducted to compare the efficacy and safety of topical, oral and intravenous routes (iv) of TXA with routine hemostasis alone in patients undergoing primary total knee arthroplasty (TKA). Materials and methods: A prospective randomized trial was conducted in patients undergoing primary TKA. Patients were divided into four groups of 50 each; group 1 received intraarticular TXA, group 2 received oral TXA three hours before surgery, group 3 received IV TXA just before tourniquet release and group 4 did not receive TXA. Post-operative drain volume (PODV), fall in haemoglobin (Hb) level and the required amount of blood transfusion were evaluated. Results: PODV and drop in Hb level respectively were (158±90 ml and 1±0.5 g/dl) in group 1, (328±149 ml and 1.7±0.7 g/dl) in group 2, (311±151 ml and 2.1±1 g/dl) in group 3 and (589±115 ml and 3.2±1.2 g/dl) in group 4. The difference in drain volume between all groups was statistically significant except between groups 2 and 3. Transfusion requirements were significantly greater in group 4 (p< 0.001). Conclusions: Intra-articular, oral and IV TXA were observed to be safe strategies and more effective than tamponade effect alone to reduce drain volume and transfusion requirements after TKA. Additionally, intra-articular TXA was better than oral or IV TXA with respect to drain volume and post-op drop in Hb