IV AND IA Tranexamic Acid Reduces Blood Loss by 37%

New research just published in the Journal of Bone and Joint Surgery has found that administering tranexamic acid (TXA) both intravenously (IV) and injected at the surgical site (intra-articular administration, or IA) reduced blood loss by 37%, compared to IV alone, following total knee replacement (TKR) surgery.

According to the May 19, 2016 news release, “In this study out of Denmark, 60 patients scheduled for TKR were randomly assigned to receive either TXA IV alone, or TXA IV and an IA dose. The TXA IV was administered at the same time as anesthesia, and the TXA IA, just prior to closing the surgical site. The patient group receiving TXA IV and IA had a 37% greater reduction in blood loss at 24 and 48 hours post-surgery, compared to the patients who received TXA IV only. No thromboembolic complications were observed in any of the patients within 90 days postoperatively. One patient in the IV-only group required a postoperative blood transfusion.”

“The clinically relevant reduction in blood loss was achieved simply, cost-effectively, and without compromising safety, potentially reducing the negative effects of blood loss on early functional recovery, the number of blood transfusions and related costs, ” said study author Henrik Husted, M.D., Ph.D., associate professor and head of orthopedics at Copenhagen University Hospital Hvidovrein Copenhagen, Denmark.

Asked if there are risks to combining these, Dr. Husted told OTW, “No, not to our knowledge. Looking at the literature, it has been shown in met analyses that intravenous TXA reduces blood loss around 600 mL and intraarticular TXA with around 450 mL, neither method was associated with increased DVT or PE. Most studies have shown that at least 2 doses result in less blood loss compared to a single dose of TXA. It has also been shown that giving TXA intraarticularly results in maintenance of TXA in the tissues for up to 17 hours and as the effect of TXA given intravenously is around 3 hours, it would make sense to combine these to have a prolonged, easily applicable, safe reduction in blood loss as has been shown in our study.

The nest logical steps are of course to study the combined application of TXA in other arthroplasty procedures like THA (where a single study so far has shown benefits of combing IV and IA on blood loss) and also bilateral simultaneous procedures and revisions and we have planned multicenter-studies awaiting ethical approvement.”

“Also, an understanding of the mechanism of how IA TXA works is essential: does it have a local effect or is just through absorption into the systemic circulation? In order to find out, we have teamed up with a French Lab doing mass spectrometry to assess the bioavailability of TXA in the blood at different time periods and this study is also awaiting ethical approval.”