title: Intraarticular Administration of Tranexamic Acid is Safe and Effective in Total Knee Arthroplasty Patients at High-Risk for Thromboembolism.
abstract: BACKGROUND
  Tranexamic acid (TXA) is an antifibrinolytic agent that can be used to reduce blood loss in total knee arthroplasty (TKA) patients. Due to its thrombogenic properties, intravenous (IV) TXA is contraindicated in patients who have an increased risk of arterial or venous thrombosis. For such patients, intraarticular (IA) TXA may be a safe alternative. In this study, we compare: 1) complication rates; 2) intraoperative blood loss; and 3) need for transfusion in TKA patients who received IA TXA versus patients who used IV TXA.
  
  
  METHODS
  A retrospective chart review of a single surgeon was performed for patients who received a TKA and had either IV TXA or IA TXA (due to increased risk of thrombosis). This yielded 60 patients who had a mean age of 65 years (range, 36 to 84 years). Twenty-six patients received IA TXA as a consequence of being ineligible for IV TXA, because of increased risk for arterial or venous thromboembolism. Thirty-four patients received IV TXA. Complication rates and need for transfusion were evaluated as categorical variables. Amount of blood loss was evaluated as a continuous variable. All categorical variables and continuous variables were analyzed using chi-square test and student's t-test respectively.
  
  
  RESULTS
  Overall, four patients (7 %) developed complications after the procedure, three of which were in the IA cohort and one in the IV cohort (p= 0.444). In the IA cohort, two patients developed arthrofibrosis and subsequently underwent manipulation under anesthesia. Additionally, one patient in this group developed a hematoma one week after TKA. This patient was managed conservatively until the condition resolved, and no further issues have been reported. One patient in the IV cohort developed a deep vein thrombosis, which was appropriately treated with no further issues. There was no significant difference in mean blood loss or number of transfusions between patients who received IA TXA or IV TXA (289 mL vs. 268 mL, p= 0.503; 3 vs. 4, p= 0.651, respectively).
  
  
  CONCLUSIONS
  High-risk patients who have contraindications against intravenous TXA may be good candidates for intraarticular TXA. Our study demonstrated no significant differences in complication rates, blood loss, and transfusion rates in patients who received intravenous TXA as compared to those who received intraarticular TXA during total knee arthroplasty. We conclude that the intraarticular administration of TXA may be a safe and effective alternative for patients who have contraindications against intravenous TXA.
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Delanois
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Chukwuweike
authors.initials: C
authors.lastname: Gwam
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Jaydev B
authors.initials: JB
authors.lastname: Mistry
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Melbin
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Prathik P
authors.initials: PP
authors.lastname: Mudaliar
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anton
authors.initials: A
authors.lastname: Khlopas
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Vidur
authors.initials: V
authors.lastname: Tangri
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006801:Humans; D008875:Middle Aged; D019106:Postoperative Hemorrhage; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid