Randomized Tranexamic Acid Total Knee Arthroplasty

The major cause of postoperative blood loss following TKA can be attributed to surgical
trauma that leads to activation of both the coagulation cascade and local fibrinolysis.(22,
23)(12) The fibrinolysis is further compounded by tourniquet release at the end of the
surgical procedure.(23) Multiple studies and meta-analyses have shown that intravenous (IV)
administration of the antifibrinolytic agent tranexamic acid (TA) reduces postoperative
bleeding and the need for transfusion.(12)(24-31) Tranexamic acid is a synthetic derivative
of the amino acid lysine and a a competitive inhibitor of plasminogen activation that
interferes with fibrinolysis.(27)

However, concerns about the safety of systemic administration of tranexamic acid have
hindered its widespread use even though multiple studies and meta-analyses have shown no
increased risk (12)(24-31). In particular, orthopedic surgeons have been concerned with the
risk of thromboembolic diseases such as deep-vein thrombosis (DVT) and pulmonary embolism
(PE) in high-risk patients. However, multiple prospective and retrospective studies, in
addition to meta-analyses, have shown absolutely no increase in DVT or PE. Regardless, an
alternative includes the topical application of tranexamic acid to the knee joint before
closure. While topical application of tranexamic acid has been shown to be a cost-effective
and simple route of reducing blood loss in dental, cardiac, and spine procedures, less data
is available in regards to total knee arthroplasty.(12) As such, the goal of this
randomized controlled, single-blinded, multicenter trial is to assess the efficacy of
topical tranexamic acid compared to a control group of patients receiving IV tranexamic
acid.