title: Use of tranexamic acid in total knee arthroplasty.
abstract: OBJECTIVE
  different strategies have been developed to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA.
  
  
  METHODS
  we enrolled all patients submitted to a primary TKA in our department between November 2014 and August 2015. They were divided into three groups corresponding to the method of TXA administration used: intravenous (IV), intra-articular (IA), and a combination of the two. Demographic data, as well as preoperative hemoglobin and platelet levels, were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions; postoperative pain was also assessed. Student's t-test or a χ2test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences.
  
  
  RESULTS
  the sample comprised 34 patients: IV, 10 cases; IA, 15 cases, and combined (IV + IA), 9 cases. The average age of the patients was 71.1±6.4 years. No significant differences in the outcome measures were found between the groups, with the exception of a significantly lower maximum hemoglobin loss in the combinedversusthe IV group (p=0.02). There were no differences between the groups in the amount of blood in thedrainor the rate of transfusions.
  
  
  CONCLUSIONS
  the data from this preliminary study, as well as data from the literature, confirm that TXA administration is safe and effective in reducing total blood loss in TKA, and no administration protocol seems to be superior to the others.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: University of Study of Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marra
authors.affiliation: AO Ordine Mauriziano, Department of Orthopaedics and Traumatology, Turin, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Rosso
authors.affiliation: AO Ordine Mauriziano, Department of Orthopaedics and Traumatology, Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bruzzone
authors.affiliation: AO Ordine Mauriziano, Department of Orthopaedics and Traumatology, Turin, Italy.
authors.forename: Davide Edoardo
authors.initials: DE
authors.lastname: Bonasia
authors.affiliation: AO Ordine Mauriziano, Department of Orthopaedics and Traumatology, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Dettoni
authors.affiliation: AO Ordine Mauriziano, Department of Orthopaedics and Traumatology, Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi
keywords: arthroplasty; bleeding; blood loss; knee; tranexamic acid