Can local administration of tranexamic acid during total knee arthroplasty reduce blood loss and transfusion requirements in the absence of surgical drains?

Blood transfusions are frequently required following total knee arthroplasty. Tranexamic acid (TXA) inhibits fibrinolysis and has been shown to reduce blood loss and transfusion requirements when delivered intravenously. Topical and intra-articular applications directly target bleeding sites whilst limiting systemic uptake and theoretically reduce the risk of thromboembolic complications. However, in the absence of surgical drains, which increase post-operative blood loss, the efficacy of these techniques for reducing transfusion requirements is unclear. Our aim was to determine if locally administered tranexamic acid during total knee arthroplasty could reduce both blood loss and transfusion requirements in the absence of surgical drains. A retrospective review of 248 patients treated with primary unilateral cemented total knee arthroplasty was performed. Patients treated after January 2011 received topical and intra-articular tranexamic acid at the end of the procedure (n = 136). A second group of consecutive patients treated before this period acted as historical controls (n = 112). Patient groups were equivalent in terms of age, gender and ASA grade. There was a significant reduction in mean blood loss of 246 ml between the groups (p < 0.01). In addition, the requirement for post-operative allogenic blood transfusion was significantly reduced from 15.5 to 5.4 % after introduction of the tranexamic acid regimen (p = 0.02). This is the largest patient cohort reviewed to measure the efficacy of locally administered tranexamic acid during total knee arthroplasty and demonstrates that this is an effective technique for reducing both blood loss and transfusion requirements in the absence of surgical drains.