Background: Blood loss during and immediately after total knee arthroplasty (TKA) is among the most challenging
concerns. It has been demonstrated that Tranexamic acid (TXA) can help to reduce perioperative blood loss. TXA
can be used as an oral, topical or intravenous injection. Many studies evaluated the effectiveness of each route of
administration but few works on a comparison between them. The current study aimed to compare the effectiveness
of intravenous injection versus topical use of TXA in reducing perioperative blood loss after primary total knee
Methods: Eighty-five patients who were a candidate for total knee arthroplasty were randomized into two groups:
one group received Intravenous injection of 15 mg/kg TXA, 10 min before tourniquet inflation while the other group
received 1 g diluted TXA during wound closure. The postoperative blood loss was estimated by measuring the
whole drain output and also hemoglobin (HB) drops. Both groups compared based on the need for allogenic blood
transfusion and also thromboembolic events.
Results: Patients who received topical TXA had a higher total drain output (P<0.0001) compared to intravenous
injection. The hemoglobin drop also was more in the topical group although it was marginally significant (P=0.05).
Conclusion: Intravenous injection of TXA is more effective in reducing postoperative blood loss after primary TKA
compared to topical administration.
Level of evidence: I