J Korean Orthop Assoc.  2021 Apr;56(2):142-149. 10.4055/jkoa.2021.56.2.142.

Efficacy of Tranexamic Acid during Primary Total Knee Arthroplasty: Comparative Study between Intravenous Use and Topical Use

  • 1Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea


This study examined the effectiveness of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty by comparing the methods of administration between an intravenous group, topical group, and non-tranexamic acid group.
Materials and Methods
This was a retrospective case series study of patients who underwent primary total knee arthroplasty from March 2017 to February 2019 performed by a single surgeon. The study population was divided into three groups according to the method of tranexamic acid administration (Group I: intravenous group, Group II: topical group, Group III: non-tranexamic acid group). To evaluate the effectiveness of tranexamic acids, the total amount of postoperative blood loss, postoperative hemoglobin loss, and volume of red blood cell transfusion in the three groups were compared.
The total amount of postoperative blood loss was lower in the tranexamic acid administered group than in the non-tranexamic acid group (1,366±866 ml). Among the administration methods, the intravenous group (987±449 ml) was significantly lower than the topical group (1,136±339 ml) (p=0.004). Postoperative hemoglobin loss was lower in the tranexamic acid group than the non-tranexamic acid group. Among the administration methods, the intravenous group was lower than the topical group. The transfusion rate was higher in the nontranexamic acid group (5.7%) than the tranexamic administered group. The transfusion rate of the intravenous group was 1.4%, and no patient required a transfusion postoperatively in the topical group. The number of postoperative thromboembolic events, as a complication of tranexamic acid, was similar in the three groups.
Tranexamic acid was effective in reducing postoperative blood loss after primary total knee arthroplasty compared to the nontranexamic acid administered group. No significant difference in the complications induced by tranexamic acid was observed among the three groups.


primary total knee arthroplasty; tranexamic acid; blood loss
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