A comparative study of effect of tranexamic acid (TXA) parenteral versuslocal administration in reducing blood loss in total knee replacement

摘要

BackgroundTotal knee arthroplasty (TKA) is a common orthopaedic surgery that results in significant blood loss due toextensive soft tissue release and bone cuts. The aim of this study is to compare blood loss between parenteralintravenous (IV) administration and local intra-articular (IA) administration of tranexamic acid (TXA), in patientsundergoing primary total knee arthroplasty.MethodsThis present study was carried out at the Orthopaedics Department, Maharaja Institute of Medical Sciences andGeneral Hospital (MIMS), Vizianagaram, India, between January 2019 and June 2020 using prospectiveobservational study methods. Fifty patients who presented to the outpatient department with grade 3 andgrade 4 Kellgren Lawrence System of classification for osteoarthritis requiring surgical intervention wereincluded: 25 in the intra-articular group (IA) and 25 in the intravenous group (IV). Chi-square tests andindependent sample t-tests were used to calculate statistical significance of the results. Pre-operativehaemoglobin levels were assessed using a haematocrit test. Haemoglobin and haematocrit levels were notedbefore surgery and 24 hours after surgery.ResultsNo significant difference was observed between intra-articular vs intravenous TXA in terms of mean post-ophaemoglobin, haematocrit and mean fall in haemoglobin using a haematocrit test in both groups (p.001).ConclusionTXA can be given through local or parentral route during surgery. Both routes of administration are equallyefficacious. The IA route is preferred over IV due to a lower risk of side effects, including deep vein thrombosis(DVT), cerebrovascular accidents (CVA), and pulmonary embolisms (PE), than with IV. Administration of intraarticular TXA after TKR is gaining in popularity and our study shows there is no statistically significant differencein efficacy noted between IA and IV routes.