Comparative Efficacy and Safety of Intravenous vs. Combined Intravenous and Intraarticular Tranexamic Acid Administration in Total Knee Arthroplasty: A Stratified Analysis Based on Bleeding Risk

Objectives: Tranexamic acid (TXA) effectively reduces blood loss in total knee arthroplasty (TKA) without raising thromboembolism risk, though the best administration route is still debated. This study aimed to classify patients based on bleeding risk factors and determine whether intravenous (IV) alone or combined IV and intraarticular (IA) administration of TXA provides the greatest benefit. Methods: This study included ۲۰۰ patients who underwent TKA, with ۱۰۰ patients with IV administration only and ۱۰۰ with combined IV and IA administration. The bleeding risk stratification criteria were based on patient body mass index, age, the use of increased anticoagulant doses in patients with atrial fibrillation, and cases where synovectomy was performed. The primary outcomes measured were tube drainage volume, hemoglobin (Hb) and hematocrit (Ht) levels, and blood transfusion rates. Secondary outcomes included wound complications, symptomatic deep vein thrombosis (DVT), and symptomatic pulmonary embolism (PE). Results: Combined IV and IA administration showed better outcomes in terms of Hb reduction (difference of ۰.۹۸ g/dl, ۹۵%CI: ۰.۶۹ to ۱.۲۶, P<۰.۰۰۰۱), Ht reduction (difference of ۲.۶۶%, ۹۵% CI: ۱.۷۸ to ۳.۵۴, P<۰.۰۰۰۱), tube drainage (۲۹۴ vs ۳۵۸ ml, ۹۵% CI: ۱۱.۵۸ to ۱۱۵.۹۳, P=۰.۰۱۷۰) and shorter hospitalization stay (difference of ۰.۵۳ days, ۹۵% CI: ۰.۱۶ to ۰.۹۰, P=۰.۰۰۵۰) compared to only IV administration. Patients who underwent synovectomy had lower tube drainage with combined TXA administration compared to IV only (۳۵۵.۴۲ ± ۱۶۱.۶۸ ml vs. ۴۲۹.۷۹ ± ۲۶۸.۴۸ ml). Neither group experienced any cases of symptomatic (i.e. DVT) or pulmonary embolism (PE). Conclusion: The combined administration of TXA (IV and IA) in patients undergoing TKA was more effective than IV-only administration.         Level of evidence: II

کلیدواژه ها:

bleeding risk ، Enhanced recovery after surgery ، intraarticular TXA ، intravenous TXA ، Physiopathology ، Total knee arthroplasty ، Tranexamic acid