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    Is There Value in Combining IV and Intra-articular Tranexamic Acid?

    At the World Arthroplasty Congress, Dr. Tae Kyun Kim presented the results of study that included administration of intravenous and intra-articular tranexamic acid in patients undergoing total knee arthroplasty.

    Orthopaedic surgeons are very interested in the use of tranexamic acid to reduce the risk of blood loss and transfusions typically associated with joint replacement surgery.

    Questions still remain, however, about safety and efficacy – including which route of administration is preferred.

    At ICJR’s recent World Arthroplasty Congress, Tae Kyun Kim, MD, PhD, from Seoul National University Bundang Hospital in Seongnam-Si, Korea, shared the results of a study he and his colleagues conducted on the use of tranexamic acid in patients undergoing total knee arthroplasty.

    The 376 patients in their study were randomized into 4 groups:

    • Intravenous (IV) administration of 10 mg/kg of tranexamic acid at tourniquet release and 3 hours later
    • Intra-articular administration of 2 grams of tranexamic acid in 30 mL of normal saline
    • Low-dose combined administration consisting of the IV regimen plus 1 gram of tranexamic acid in 30 mL of normal saline
    • High-dose combined administration consisting of the IV regimen plus 2 grams of tranexamic acid in 30 mL of normal saline

    All patients received spinal anesthesia, a peripheral nerve block, periarticular injection of anesthetics, 500 mL of IV fluids after surgery, oxygen at 2 L/hour for 24 hours, and prophylaxis for deep vein thrombosis (DVT).

    Hemoglobin levels were evaluated as part of the efficacy protocol. The transfusion trigger was a hemoglobin level below 7.0 g/dL; these patients would receive a transfusion of red blood cells. Patients with a hemoglobin level between 7.0 and 8.0 would receive fluids and iron intravenously.

    Dr. Kim and his colleagues found that patients in the IV-only group had a higher total blood loss (P<0.001) and greater drop in hemoglobin level (P<0.001) than any of the other groups. The smallest blood loss and drop in hemoglobin was seen in the high-dose combined group. None of the patients needed an allogeneic blood transfusion.

    There was only 1 pulmonary embolism in the IV-only group and no DVTs in any group. A few patients had wound complications, and these occurred across the 4 groups.

    Dr. Kim and his colleagues concluded that combined IV/intra-articular administration of tranexamic acid is not necessary for routine total knee arthroplasty procedures – intra-articular administration alone provides comparable reduction in blood loss without increased complications. Combined administration may be a benefit in simultaneous bilateral procedures, however, because of the greater risk of blood loss.

    Dr. Kim discussed the results of the study in an exclusive interview with ICJR. Click the image above to hear his comments.

    Producer and Director: Michael Bugera; Post Production: Ryan Waczek