Efficacy and safety of multiple boluses of oral versus intravenous tranexamic acid at reducing blood loss after primary total knee arthroplasty without a tourniquet: A prospective randomized clinical trial.

INTRODUCTION: The aim of this study was to examine whether the administration of multiple boluses of oral or intravenous tranexamic acid (TXA) postoperatively were equivalent at reducing blood loss and the inflammatory and fibrinolytic responses in primary total knee arthroplasty (TKA) without a tourniquet.

MATERIALS AND METHODS: In this prospective, double-blinded, randomized trial, patients undergoing primary THA were randomized into either an oral or intravenous TXA group. All patients received 1 dose of 20 mg/kg intravenous TXA 5-10 min before skin incision. Patients in the oral TXA group then received 3 doses of 2 g oral TXA at 4, 10, and 16 h postoperatively, while patients in the intravenous TXA group received 3 doses of 1 g intravenous TXA at 6, 12, and 18 h after surgery.

RESULTS: There was no significant difference in the hemoglobin (Hb) or hematocrit (Hct) drop on postoperative day 1 (14.7 ± 10.5 vs 14.4 ± 9.6 g/L, p = 0.869; 0.042 ± 0.032 vs 0.040 ± 0.028, p = 0.781) and 3 (22.6 ± 10.6 vs 20.5 ± 9.7 g/L, p = 0.300; 0.059 ± 0.031 vs 0.054 ± 0.031, p = 0.332). No patients needed an allogeneic blood transfusion. The mean total blood loss, hidden blood loss, length of hospital stay, the level of inflammatory and fibrinolytic markers on the first and third postoperative days, and the incidence of complications were not significantly different between the two groups (p > 0.05).

CONCLUSION: There was no difference in Hb and Hct drop, blood loss, inflammatory and fibrinolytic responses in primary TKA without a tourniquet between those who received multiple boluses of oral or intravenous TXA after surgery in current scheme.