Comparative Efficacy of Intravenous, Topical, and Combined Tranexamic Acid for Blood Conservation in Total Knee Arthroplasty
Keywords:
tranexamic acid; total knee arthroplasty; blood loss; transfusion; topical; intravenous; orthopaedicsAbstract
Background: Total knee arthroplasty (TKA) is associated with substantial perioperative blood loss and a meaningful transfusion burden. Tranexamic acid (TXA) is established for blood conservation, but the optimal route of administration remains debated. This study compared intravenous (IV), topical, and combined IV plus topical TXA. Methods: In a single-centre prospective comparative study, 250 patients undergoing primary unilateral TKA were allocated to three regimens. The primary outcome was calculated total blood loss; secondary outcomes were haemoglobin drop, transfusion rate, length of stay, and thromboembolic events. Results: Combined administration produced the lowest mean total blood loss (742 mL) versus IV (968 mL) and topical (1012 mL), with the smallest haemoglobin drop and lowest transfusion rate. Symptomatic venous thromboembolism did not differ between groups. Conclusion: Combined IV and topical TXA offers superior blood conservation in TKA without an increased thrombotic signal, supporting its routine adoption.
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