Erin Raley Wilson: The Safety and Efficacy of Topical Tranexamic Acid Versus Intravenous Tranexamic Acid in Total Knee Arthroplasty

The Safety and Efficacy of Topical Tranexamic Acid Versus Intravenous Tranexamic Acid in Total Knee Arthroplasty

ABSTRACT

Background: Perioperative blood loss is of major concern for patients undergoing a total knee arthroplasty (TKA). Multiple studies have confirmed the ability of tranexamic acid (TXA), an antifibrinolytic agent, to effectively reduce blood loss and transfusion rates following TKA, without increasing the risk of thromboembolic events. However, much controversy remains about the optimal regimen of TXA in primary TKA. The purpose of this systematic review is to compare the safety and efficacy of topical TXA versus intravenous (IV) TXA in primary TKA.

Methods: An exhaustive literature search was performed using MEDLINE-Ovid, Web of Science, and Google Scholar. The following search terms were utilized: “total knee arthroplasty” OR “total knee replacement” AND “tranexamic acid.” All randomized studies comparing the effectiveness of topical versus intravenous TXA in primary, unilateral TKA were included. Analysis focused on specific outcomes including total drain blood loss, postoperative hemoglobin (Hb) drop, frequency of transfusion, and thromboembolic complications. The quality of evidence was assessed using a system known as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results: Of 194 papers identified, four trials were eligible for review. Analysis showed no significant differences in total drain blood loss, postoperative Hb drop, frequency of transfusion, or thromboembolic complications when comparing topical TXA and IV TXA in primary, unilateral TKA.

Conclusion: The results of this review demonstrate that the topical administration of tranexamic has similar efficacy and safety profile to that of intravenous tranexamic acid in reducing blood loss and transfusion rates in primary TKA.

Keywords: Tranexamic acid, topical, intra-articular, intravenous, total knee arthroplasty, total knee replacement

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REVIEWED STUDIES:

Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Perez-Chrzanowska H, Figueredo-Zalve R. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial. Journal of Bone & Joint Surgery – American Volume. 2014;96:1937-1944.

Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study.

Soni A, Saini R, Gulati A, Paul R, Bhatty S, Rajoli SR. Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty. J Arthroplasty. 2014;29:1525-1527.

Seo JG, Moon YW, Park SH, Kim SM, Ko KR. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21:1869-1874.

AUTHOR: Erin Wilson is currently completing her second year in the School of PA Studies at Pacific University, Oregon.  She will graduate with an MS degree in August, 2016.