Research Article
Volume 11 Issue 11 - 2020
A Comparative Study Determining the Efficacy of Intravenous Versus Topical Tranexamic Acid Administration in Total Knee Arthroplasty
Ahsan Javaid Butt, Fares Uddin, Yousaf Alkhalfan, Muhammad Zain-ur-Rehman*, Salman Langawi and Hesham Alkhateeb
King Hamad University Hospital, Kingdom of Bahrain
*Corresponding Author: Muhammad Zain-ur-Rehman, Specialist Registrar, King Hamad University Hospital, Kingdom of Bahrain.
Received: September 16, 2020; Published: October 30, 2020


Introduction: Total knee replacements are one of the most common Orthopaedic procedures performed worldwide and the numbers are rising at exponential rates. Blood loss is a significant concern among the population in which it is commonly performed, infrequently necessitating blood transfusion. The use of tranexamic acid (TXA) has been shown to be efficacious in reducing perioperative bleeding as well as subsequent transfusion rates by multiple meta analyses. But the efficacy and safety of one route of administration over the other are yet to be clearly defined.

Methodology: We present a retrospective cohort study evaluating intravenous (IV) versus topical TXA administration among 120 patients undergoing total knee replacements at a single centre using similar implants and surgical techniques.

Results and Discussion: The mean drop in haemoglobin postoperatively was 0.93 g/dL and 0.89 g/dL in the topical and intravenous groups respectively. These were not found to be statistically significant. No difference was found when assessing for average length of stay, transfusion rates, thromboembolic events, infection and mortality.

Several randomized control trials have demonstrated equal efficacy of topical tranexamic acid administration compared to topical when evaluating for blood loss, transfusion rates, and thromboembolic events. Although topical administration may not be able to achieve optimal therapeutic levels in the local tissues - this has not demonstrably translated into clinical findings. the evidence suggests that the use of topical TXA is superior to its IV counterpart in reducing the overall hospital cost per total knee arthroplasty whilst being equally efficacious in reducing the need for blood transfusions.

Conclusion: Our study demonstrates similar outcomes between IV and topical TXA administration with no reported adverse events. Further studies are needed to establish the ideal dosing, delivery method and whether additional therapeutic agents can further help improve outcomes following total knee arthroplasty.

Keywords: Total Knee Arthroplasty; Total Knee Replacement; Blood Loss; Tranexamic Acid      


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Citation: Muhammad Zain-ur-Rehman., et al. “A Comparative Study Determining the Efficacy of Intravenous Versus Topical Tranexamic Acid Administration in Total Knee Arthroplasty”.EC Orthopaedics 11.11 (2020): 51-58.

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