The efficacy of different administration of tranexamic acid (TXA) and use of tourniquet on reducing blood loss in patients undergoing total knee arthropasty (TKA)

Background: The aim of this study was to compare the efficacy of different administration of tranexamic acid (TXA) and use of tourniquet on reducing blood loss in patients undergoing total knee arthropasty (TKA). Methods: Ninety six patients were equally randomized to 4 groups. Group A received one dose of TXA (10 % Transamin 250 mg ,20 mg/kg) and 2 g TXA intraarticular after skin closure but without tourniquet. Group B was treated only with a tourniquet. Group C was treated with a tourniquet as well as one dose of intravenous TXA (10 % Transamin 250 mg ,20 mg/kg). Group D was treated with 2 g TXA intraarticular after skin closure but without tourniquet. The results were analyed based on post-operative blodd loss, change in heamglobin (Hb) level and heamatocrit (PCV) and the need for blood transfusion. Results: The level of post-operative Hb and PCV were similar for the 4 groups. The number of transfusions were less in Group A than the other groups (p=0.48). Drain output was significantly lower in Group A (p < 0.001). Intraoperative blood loss was higher in Group D than the other groups (p<0.001). The fall in Hb and PCV level were significantly lower in Group A (p=0,27) Conclusion: Patients received intravenous and topical TXA without tourniquet had less fall in Hb and PCV, lower drain output, less need for transfusion. Patients treated with tourniquet had lower intraoperative blood loss. Our results suggest that topical and intravenous administration of TXA could reduce transfusion rates and fall in Hb and PCV level.