Intra-articular versus Intravenous Tranexamic Acid in Total Knee Arthroplasty: A Randomized Clinical Trial



Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran


Background: Total knee arthroplasty (TKA) can cause excessive blood loss requiring allogenic transfusions.
Tranexamic acid (TXA) has been increasingly used for lowering blood loss. The present study aimed to compare
the efficacy of intravenous (IV) and intra-articular (IA) administrations of TXA in TKA patients who receive aspirin as
chemoprophylaxis and uses no drain post-operative.
Methods: In this prospective randomized clinical trial, 49 TKA patients were intravenously given 15 mg/kg dose of
TXA, and 49 patients intraarticularly received 15 mg/kg of TXA. Demographic information, pre-operative and postoperative
hemoglobin values of the patients were used for assessing total perioperative blood loss by GOOD &
NADLER formulae.
Results: There was not any significant difference between the IV TXA and IA TXA groups concerning blood loss
(P=0.102). However, the decrease in hemoglobin level at 48 hours post-operation compared to the preoperative
level in the IV TXA group was significantly higher than that in the IA TXA group (-2.3 ±0.8 vs. -1.9 ±1.0 g/dL;
P=0.038). No blood transfusion was needed, and the deep venous thrombosis and pulmonary embolization were
not observed in either of the groups (P>0.05).
Conclusion: Our study showed that during TKA, the IA TXA is equally safe and effective as its IV infusion concerning
decreased blood loss and adverse effects. The use of TXA during TKA is safe for patients who receive less potent
chemoprophylaxis agents such as aspirin.
Level of evidence: I