Comparison of the Effects of Intravenous and Topical Tranexamic Acid with Its Combined Method on Reducing Postoperative Bleeding After Knee Arthroplasty

Jafari Zareh, Mohammad Ali; Sadeghpour, Alireza; Elmi, Asghar; Yousefi-jenaghard, Amirreza; Banimohammad, Majid

doi:10.22034/ijos.2025.228148

Comparison of the Effects of Intravenous and Topical Tranexamic Acid with Its Combined Method on Reducing Postoperative Bleeding After Knee Arthroplasty

Document Type : Original Article

Authors

Mohammad ali Jafari zareh ¹

alireza Sadeghpour ²

Asghar Elmi ³

amirreza Yousefi-jenaghard ⁴

Majid Banimohammad ⁵

¹ ardabil

² Tabriz University of Medical Sciences

³ tabriz university of medical sciences

⁴ Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran

⁵ Department of Medicine Faculty, Islamic Azad University Ardabil, Ardabil, Iran

https://doi.org/10.22034/ijos.2025.228148

Abstract

Abstract
Introduction: Postoperative bleeding is a major concern in total knee arthroplasty (TKA), often leading to complications such as anemia and increased demand for blood transfusion. Tranexamic acid (TXA), an antifibrinolytic agent, is used intravenously and topically to reduce surgical blood loss. This study aimed to compare the efficacy of three administration methods of TXA (intravenous, topical, and combined) in reducing bleeding among Iranian patients.
Materials & Methods: This double-blind randomized clinical trial (RCT) was conducted on 135 patients undergoing TKA, between February 2021 and June 2021. Patients were randomly assigned to three groups of 45 each: intravenous, topical, and combined. Demographic data, postoperative drainage volume, hemoglobin changes, and other clinical variables were analyzed using SPSS software.
Results & Discussion: The combined TXA group showed a statistically significant reduction in intraoperative bleeding (524.0 ± 150.5 mL) compared to the intravenous (665.6 ± 136.3 mL) and topical (740.2 ± 141.5 mL) groups (p<0.05). This group also experienced a smaller postoperative drop in hemoglobin. No significant differences were observed among the groups in terms of edema or knee circumference (p>0.05).
Conclusion: The combined administration of intravenous and topical TXA was more effective in reducing postoperative drainage volume and hemoglobin drop, compared to either method alone. These findings support the superiority of the combined approach and highlight the importance of TXA use in managing bleeding in orthopedic surgeries.

Keywords

Postoperative hemorrhage

Total knee replacement

Tranexamic acid

Subjects