Navendu Goyal1, Darren B Chen1, Ian A Harris2, Neville J Rowden3, George Kirsh4, Samuel J MacDessi1. 1. Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia. 2. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, New South Wales, Australia. 3. St George Knee Clinic, New South Wales, Australia. 4. St George Private Hospital, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: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). METHODS: This 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. RESULTS: Of 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. CONCLUSION:IA 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.
RCT Entities:
BACKGROUND: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). METHODS: This 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. RESULTS: Of 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. CONCLUSION: IA 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.
Authors: Scott M Bolam; Arama O'Regan-Brown; A Paul Monk; David S Musson; Jillian Cornish; Jacob T Munro Journal: Knee Surg Sports Traumatol Arthrosc Date: 2020-08-29 Impact factor: 4.342
Authors: Nicholas P Drain; Valerie C Gobao; Dominique M Bertolini; Clair Smith; Neel B Shah; Scott D Rothenberger; Malcolm E Dombrowski; Michael J O'Malley; Brian A Klatt; Brian R Hamlin; Kenneth L Urish Journal: J Arthroplasty Date: 2020-03-04 Impact factor: 4.757