Prospective double-blind RCT of 99 patients undergoing primary cemented TKA. Tested whether 1.5 g or 3.0 g of tranexamic acid applied topically into the open joint for five minutes before closure reduces postoperative blood loss versus saline placebo. Primary outcome was calculated blood loss based on hemoglobin balance.
Concerns about thromboembolic risk with intravenous tranexamic acid had slowed adoption of antifibrinolytics in TKA — particularly for patients already at high baseline VTE risk. This trial offered a workaround: deliver the drug locally, where the bleeding is, and keep systemic exposure low.
When closing a primary TKA, apply 1.5 g tranexamic acid in 100 mL saline into the open joint, leave it for five minutes, then suction the excess before closure. This single step reduces blood loss by roughly 300-400 mL and keeps postoperative hemoglobin approximately 1.4 g/dL higher than placebo. Without increasing DVT or PE rates.
The 1.5 g and 3.0 g doses are equivalent, so there is no reason to use the higher dose. At roughly $6 per case, topical tranexamic acid is also dramatically cheaper than fibrin sealants (approximately $585 per case) with comparable efficacy.
This paper is foundational to why topical tranexamic acid became a standard blood-conservation tool in arthroplasty, and it sets up the later body of work comparing topical versus intravenous versus combined dosing strategies.
Prospective double-blind RCT of 99 patients undergoing primary cemented TKA. Tested whether 1.5 g or 3.0 g of tranexamic acid applied topically into the open joint for five minutes before closure reduces postoperative blood loss versus saline placebo. Primary outcome was calculated blood loss based on hemoglobin balance.
Concerns about thromboembolic risk with intravenous tranexamic acid had slowed adoption of antifibrinolytics in TKA — particularly for patients already at high baseline VTE risk. This trial offered a workaround: deliver the drug locally, where the bleeding is, and keep systemic exposure low.
When closing a primary TKA, apply 1.5 g tranexamic acid in 100 mL saline into the open joint, leave it for five minutes, then suction the excess before closure. This single step reduces blood loss by roughly 300-400 mL and keeps postoperative hemoglobin approximately 1.4 g/dL higher than placebo. Without increasing DVT or PE rates.
The 1.5 g and 3.0 g doses are equivalent, so there is no reason to use the higher dose. At roughly $6 per case, topical tranexamic acid is also dramatically cheaper than fibrin sealants (approximately $585 per case) with comparable efficacy.
This paper is foundational to why topical tranexamic acid became a standard blood-conservation tool in arthroplasty, and it sets up the later body of work comparing topical versus intravenous versus combined dosing strategies.