title: Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty.
abstract: OBJECTIVE
  The surgical stress of total knee arthroplasty (TKA) procedure and the application of intra-operative pneumatic thigh tourniquet increases local fibrinolytic activity, which contributes significantly to post-operative blood loss. Tranexamic acid, an antifibrinolytic drug, is commonly used to control post-operative blood loss. The recommended mode of administration of tranexamic acid is either oral or intravenous. However, the mechanism of action of the tranexamic acid points towards the possible effectiveness it may have following local/intra-articular application. This prospective, double-blinded, randomized preliminary study evaluated the efficacy of intra-articular tranexamic acid in reducing TKA-associated post-operative blood loss.
  
  
  METHODS
  Fifty consenting patients with osteoarthritis of the knee scheduled for primary unilateral cemented-TKA were randomly allocated to one of the two groups: Tranexamic Acid (TA) group (n = 25, 500 mg/5 ml tranexamic acid) and the control group (n = 25, 5 ml 0.9% saline). The drug and control solution were administered intra-articularly through the drain tube immediately after the wound closure. Parameters related to blood loss (drop in haemoglobin, haematocrit differential) and the drain output [volume (ml)] were compared between the two groups.
  
  
  RESULTS
  On a comparative basis, TA-group obtained significant reduction in the drain output [95% CI: 360.41-539.59, p < 0.001] at 48 h post-operatively. Even though the control group received sixfold more blood transfusion than TA-group, it showed a greater drop in haemoglobin and haematocrit (p < 0.05).
  
  
  CONCLUSIONS
  Local application of tranexamic acid seems to be effective in reducing post-TKA blood loss as well as blood transfusion requirements.
  
  
  METHODS
  Therapeutic study, Level II.
authors.affiliation: Joint Replacement and Reconstruction Unit, Sir Ganga Ram Hospital, New Delhi, India. roy_sp27@yahoo.co.in
authors.forename: Shuvendu Prosad
authors.initials: SP
authors.lastname: Roy
authors.forename: Umair Firdos
authors.initials: UF
authors.lastname: Tanki
authors.forename: Amitabh
authors.initials: A
authors.lastname: Dutta
authors.forename: Sumit Kumar
authors.initials: SK
authors.lastname: Jain
authors.forename: Onkar Nath
authors.initials: ON
authors.lastname: Nagi
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001803:Blood Transfusion; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000188:drug therapy*; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid