Publication:

A comparative study between intravenous alone and combined intravenous and intra-articular administration of tranexamic acid in primary total knee replacement patients

Background With the better understanding of the total knee arthroplasty, the number of patients with extremes of ages and advanced comorbidities undergoing total knee arthroplasty are increasing. The most common post-operative complication remains the blood loss. The intravenous use of tranexamic acid was initially thought to decrease the blood loos. Over the past years, intra-articular administration of Tranexamic acid is also being used to reduce the blood loss. Now there is an  increasing trend to combine the intravenous and intra-articular route for tranexamic acid in patients undergoing total knee arthroplasty. There are very few studies that evaluates or compares the intravenous and combination of intravenous and intra-articular route of tranexamic acid in total knee arthroplasty patients.

Methods Two Hundred and two patients with severe knee osteoarthrosis planned for total knee arthroplasty were selected in accordance to inclusion and exclusion criteria. Patients were divided into Group A and B and was administered with  combination of intravenous and intra-articular tranexamic acid for Group A patients and  intravenous tranexamic acid for Group B patients .The outcome was measured in terms of blood loss in post-operative day one calculated using classical Nadir Method.

Results The blood loss were found to be 328.04±178.9 ml in Group A and 362.88±220.408 ml in Group B.  The p value was found to be greater than 0.005 and hence the difference in post-operative blood loss in both group was not statistically significant.

Conclusions There is no difference between the combination of Intra-venous Transexmic and Intra-articular Tranexamic acid when compared with intravenous Tranexamic acid in reducing blood loss in patients undergoing total knee arthroplasty.