title: Safety and efficacy of intra-articular tranexamic acid injection without drainage on blood loss in total knee arthroplasty: A randomized clinical trial.
abstract: BACKGROUND
  Major blood loss is unavoidable after primary total knee arthroplasty (TKA). The aim of this study was to determine if tranexamic acid (TXA) can reduce major blood loss following TKA.
  
  
  METHODS
  In this double-blind, randomized, placebo-control trial, 60 patients treated with unilateral primary cement TKA between August 1st 2013 and September 30th 2013 were randomized into TXA 500 mg intra-articular injection without drainage (test group, 30 knees) and 30 patients with saline intra-articular injection (control group, 30 knees).
  
  
  RESULTS
  There was a significant reduction in mean blood loss (560.55 mL) between the groups at postoperative day (POD) 5 (999.22 mL vs. 1559.77 mL, P = 0.001). The maximum hemoglobin drop was identified at POD 3 (10.51 g/dL vs. 9.10 g/dL, mean difference = 1.41 g/dL). Also, there was a significant reduction in red blood cell and hematocrit loss (P = 0.001). The transfusion rates (0% vs. 23.3%, P = 0.011) and average amount transfused (0.00 ± 0.00 units vs. 0.53 ± 1.04 units, P = 0.009) were significantly lower in the TXA group compared with control group. No significant difference in coagulation marker changes were found between TXA and control groups (P > 0.05), but the D-dimer levels at 3 and 5 days post-TKA were statistically lower in the TXA group (P < 0.05). No significant changes in the rate of symptomatic deep venous thrombosis, pulmonary embolism, or wound healing problems were noted.
  
  
  CONCLUSIONS
  TXA treatment without drainage during TKA reduces the amount of blood transfusions required without increasing the rate of adverse events.
authors.affiliation: Tianjin Medical University, General Hospital, Orthopedics Department, 300052 Tianjin, China.
authors.forename: Chen-guang
authors.initials: CG
authors.lastname: Wang
authors.affiliation: Center for Joint Diseases, Tianjin Union Hospital, 300000 Tianjin, China.
authors.forename: Zhen-hui
authors.initials: ZH
authors.lastname: Sun
authors.affiliation: Center for Joint Diseases, Tianjin Hospital, 300211 Tianjin, China; Tianjin Medical University, 300070 Tianjin, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Center for Joint Diseases, Tianjin Hospital, 300211 Tianjin, China.
authors.forename: Jian-gang
authors.initials: JG
authors.lastname: Cao
authors.affiliation: Tianjin Medical University, General Hospital, Orthopedics Department, 300052 Tianjin, China; Department of Immunology, Tianjin Medical University, 300070 Tianjin, China. Electronic address: hansontijmu@gmail.com.
authors.forename: Zhi-jun
authors.initials: ZJ
authors.lastname: Li
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D004311:Double-Blind Method; D004322:Drainage; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D014148:Tranexamic Acid / Q000008:administration & dosage*
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014148:Tranexamic Acid
keywords: Blood loss; D-dimer; Hemoglobin; Total knee arthroplasty; Tranexamic acid