title: Intravenous vs Intra-Articular Tranexamic Acid in Total Knee Arthroplasty: A Randomized, Double-Blind Trial.
abstract: Tranexamic acid (TXA) is commonly used in primary total knee arthroplasty (TKA); however, the most appropriate route of administration is still debated. This study was conducted to compare the 2 most commonly used routes of TXA administration, intravenous (IV) and intra-articular (IA).
  
  
  
  This study was conducted as a double-blind, randomized, noninferiority trial and included patients undergoing primary unilateral TKA. Patients were randomized to receive IV or IA TXA and compared for postoperative fall in hemoglobin (Hb) on day 1 (primary outcome) and day 2, and blood transfusion rates, length of stay, and complications.
  
  
  
  Of the 183 patients recruited, 168 were included and supplied complete data. The between-group difference in mean Hb fall at day 1 was 0.08 g/dL with the Hb fall higher in the IA group. The 95% confidence interval was -0.18 to 0.34 which did not reach the noninferiority margin of 0.5 g/dL. No significant difference was seen in the secondary outcomes.
  
  
  
  IA TXA is noninferior to IV TXA in terms of fall in Hb on the first postoperative day. Due to the potential for reduced serum levels and easier administration (single dose), this trial supports the use of IA TXA for primary TKA.
authors: Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia.
authors: Navendu
authors: N
authors: Goyal
authors: Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia.
authors: Darren B
authors: DB
authors: Chen
authors: Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, New South Wales, Australia.
authors: Ian A
authors: IA
authors: Harris
authors: St George Knee Clinic, New South Wales, Australia.
authors: Neville J
authors: NJ
authors: Rowden
authors: St George Private Hospital, Sydney, New South Wales, Australia.
authors: George
authors: G
authors: Kirsh
authors: Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia.
authors: Samuel J
authors: SJ
authors: MacDessi
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004311:Double-Blind Method; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D014148:Tranexamic Acid / Q000008:administration & dosage*
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid
keywords: blood loss; intra-articular; intravenous blood transfusion; morbidity; total knee arthroplasty; tranexamic acid