Comparison of combined intraarticular (IA) and intravenous (IV) administration of tranexamic acid with IA and IV alone in patients undergoing total knee arthroplasty without drainage catheter: a clinical trial study

Document Type : RESEARCH PAPER


1 Tehran University of Medical Sciences; Joint Reconstruction Research Center

2 Tehran University of Medical Sciences

3 Joint Reconstruction Research Center Imam Khomeini Hospital Tehran University of Medical Sciences

4 Tehran university of medical scince

5 Tehran University of Medical Sciences Joint Reconstruction Research Center


Purpose: we aim to determine the most effective route for TXA administration (among IA, IV, combined IA/IV) for TKA surgeries using tourniquet without drainage catheters

Methods: We performed a double-blinded clinical trial on a total of 147 TKA candidates. The amount of blood loss and hemoglobin drop were evaluated in three matched case groups administered TXA during the TKA either via IV, IA or IV plus IA route. Drainage catheter was used for none of the cases.

Results: The combined group showed an average blood loss of 630±252 ml which was significantly lower than the IV group (878±268 ml, P-value<0.01) and the IA group (774±288 ml, P-value=0.03). Besides, the mean hemoglobin and hematocrit drop was significantly lower in the combined group compared to the other two groups, 48 and 72 hours postoperatively (P value<0.05).

Conclusions: The TXA administration via IV plus IA route had 28% and 19% reduction of blood loss in comparison with using the TXA via IV alone and IA alone methods respectively. Therefore, given the surgery is performed with tourniquet application, TXA usage via IV plus IA route may be a more effective way for reducing the perioperative blood loss in TKA cases in patients undergoing TKA without drain placement.


Main Subjects

Articles in Press, Accepted Manuscript
Available Online from 08 January 2023
  • Receive Date: 10 April 2022
  • Revise Date: 01 October 2022
  • Accept Date: 02 October 2022
  • First Publish Date: 08 January 2023