Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Background: Tranexamic acid (TXA) is widely accepted as an effective method for reducing blood loss after total knee arthroplasty (TKA). As different routes of local TXA administration have been proposed to minimize systemic complications, we aimed to investigate the effectiveness and systemic absor...

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Autores principales:	Piya Pinsornsak, MD, Jakkarin Phunphakchit, MD, Krit Boontanapibul, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Tranexamic acid Peri-articular injection Intra-articular injection Total knee arthroplasty Blood loss Hemoglobin Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/785dce837cbf433c930a73f7eeeb8c42
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spelling	oai:doaj.org-article:785dce837cbf433c930a73f7eeeb8c422021-11-14T04:33:42ZEfficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial2352-344110.1016/j.artd.2021.06.005https://doaj.org/article/785dce837cbf433c930a73f7eeeb8c422021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352344121001023https://doaj.org/toc/2352-3441Background: Tranexamic acid (TXA) is widely accepted as an effective method for reducing blood loss after total knee arthroplasty (TKA). As different routes of local TXA administration have been proposed to minimize systemic complications, we aimed to investigate the effectiveness and systemic absorption of peri-articular (PA) and intra-articular (IA) administration of TXA after primary TKA. Methods: In a randomized controlled trial of patients scheduled for unilateral primary TKA, 108 were assigned to receive PA-TXA (15 mg/kg), IA-TXA (2 g), or no TXA injection. We assessed total blood loss, blood transfusion rate, and hemoglobin level changes 48 hours after surgery. Postoperative serum TXA levels, complications, and clinical symptoms of venous thromboembolism events were also evaluated. Results: Total blood loss, hemoglobin level decreases, and blood transfusion rates in both TXA groups were significantly lower than those in the control group (P < .05), without significant differences between PA and IA groups 48 hours after surgery. Serum TXA levels in the IA group were significantly higher than those in the PA cohort at 2 hours (28.2 mg/L vs 15.6 mg/L, P < .01) and 24 hours (4.4 mg/L vs 1.7 mg/L, P < .01) postoperatively. No wound complications were found in both TXA groups, but 14% of the control group developed subcutaneous ecchymoses. No evidence of venous thromboembolism events was reported. Conclusions: PA-TXA is an excellent alternative route of local TXA injection to decrease postoperative blood loss after TKA. PA-TXA demonstrated lower levels of postoperative serum TXA, which may be beneficial for high-risk patients.Piya Pinsornsak, MDJakkarin Phunphakchit, MDKrit Boontanapibul, MDElsevierarticleTranexamic acidPeri-articular injectionIntra-articular injectionTotal knee arthroplastyBlood lossHemoglobinOrthopedic surgeryRD701-811ENArthroplasty Today, Vol 11, Iss , Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tranexamic acid Peri-articular injection Intra-articular injection Total knee arthroplasty Blood loss Hemoglobin Orthopedic surgery RD701-811
spellingShingle	Tranexamic acid Peri-articular injection Intra-articular injection Total knee arthroplasty Blood loss Hemoglobin Orthopedic surgery RD701-811 Piya Pinsornsak, MD Jakkarin Phunphakchit, MD Krit Boontanapibul, MD Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial
description	Background: Tranexamic acid (TXA) is widely accepted as an effective method for reducing blood loss after total knee arthroplasty (TKA). As different routes of local TXA administration have been proposed to minimize systemic complications, we aimed to investigate the effectiveness and systemic absorption of peri-articular (PA) and intra-articular (IA) administration of TXA after primary TKA. Methods: In a randomized controlled trial of patients scheduled for unilateral primary TKA, 108 were assigned to receive PA-TXA (15 mg/kg), IA-TXA (2 g), or no TXA injection. We assessed total blood loss, blood transfusion rate, and hemoglobin level changes 48 hours after surgery. Postoperative serum TXA levels, complications, and clinical symptoms of venous thromboembolism events were also evaluated. Results: Total blood loss, hemoglobin level decreases, and blood transfusion rates in both TXA groups were significantly lower than those in the control group (P < .05), without significant differences between PA and IA groups 48 hours after surgery. Serum TXA levels in the IA group were significantly higher than those in the PA cohort at 2 hours (28.2 mg/L vs 15.6 mg/L, P < .01) and 24 hours (4.4 mg/L vs 1.7 mg/L, P < .01) postoperatively. No wound complications were found in both TXA groups, but 14% of the control group developed subcutaneous ecchymoses. No evidence of venous thromboembolism events was reported. Conclusions: PA-TXA is an excellent alternative route of local TXA injection to decrease postoperative blood loss after TKA. PA-TXA demonstrated lower levels of postoperative serum TXA, which may be beneficial for high-risk patients.
format	article
author	Piya Pinsornsak, MD Jakkarin Phunphakchit, MD Krit Boontanapibul, MD
author_facet	Piya Pinsornsak, MD Jakkarin Phunphakchit, MD Krit Boontanapibul, MD
author_sort	Piya Pinsornsak, MD
title	Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial
title_short	Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial
title_full	Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial
title_fullStr	Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial
title_full_unstemmed	Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial
title_sort	efficacy and systemic absorption of peri-articular versus intra-articular administration of tranexamic acid in total knee arthroplasty: a prospective randomized controlled trial
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/785dce837cbf433c930a73f7eeeb8c42
work_keys_str_mv	AT piyapinsornsakmd efficacyandsystemicabsorptionofperiarticularversusintraarticularadministrationoftranexamicacidintotalkneearthroplastyaprospectiverandomizedcontrolledtrial AT jakkarinphunphakchitmd efficacyandsystemicabsorptionofperiarticularversusintraarticularadministrationoftranexamicacidintotalkneearthroplastyaprospectiverandomizedcontrolledtrial AT kritboontanapibulmd efficacyandsystemicabsorptionofperiarticularversusintraarticularadministrationoftranexamicacidintotalkneearthroplastyaprospectiverandomizedcontrolledtrial
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Efficacy and Systemic Absorption of Peri-articular Versus Intra-articular Administration of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

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