Intravenous vs Intra-Articular Tranexamic Acid in Total Knee Arthroplasty: A Randomized, Double-Blind Trial

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• 作者：Navendu Goyal ; MBBS ; MS (Ortho) ; DNB (Ortho)^a ; Darren B. Chen ; MBBS ; FRACS (Ortho)^a ; Ian A. Harris ; MBBS ; FRACS (Ortho)^b ; Neville J. Rowden ; MBBS ; FRACS (Ortho)^c ; George Kirsh ; MBBS ; FRACS (Ortho)^d ; Samuel J. MacDessi ; MBBS ; FRACS (Ortho)^a ;
• 关键词：tranexamic acid ; total knee arthroplasty ; intra-articular ; intravenous blood transfusion ; blood loss ; morbidity
• 刊名：The Journal of Arthroplasty
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：32
• 期：1
• 页码：28-32
• 全文大小：427 K
• 卷排序：32

文摘

Tranexamic acid (TXA) is commonly used in primary total knee arthroplasty (TKA); however, the most appropriate route of administration is still debated. This study was conducted to compare the 2 most commonly used routes of TXA administration, intravenous (IV) and intra-articular (IA).MethodsThis study was conducted as a double-blind, randomized, noninferiority trial and included patients undergoing primary unilateral TKA. Patients were randomized to receive IV or IA TXA and compared for postoperative fall in hemoglobin (Hb) on day 1 (primary outcome) and day 2, and blood transfusion rates, length of stay, and complications.ResultsOf the 183 patients recruited, 168 were included and supplied complete data. The between-group difference in mean Hb fall at day 1 was 0.08 g/dL with the Hb fall higher in the IA group. The 95% confidence interval was −0.18 to 0.34 which did not reach the noninferiority margin of 0.5 g/dL. No significant difference was seen in the secondary outcomes.ConclusionIA TXA is noninferior to IV TXA in terms of fall in Hb on the first postoperative day. Due to the potential for reduced serum levels and easier administration (single dose), this trial supports the use of IA TXA for primary TKA.