Effect of Topical Tranexamic Acid in Reducing Bleeding and Transfusions in TKA

Educational Objectives As a result of reading this article, physicians should be able to: 1. Recognize the efficacy and safety of topical tranexamic acid (TXA) for reducing bleeding and transfusions in total knee arthroplasty (TKA). 2. Describe the main methods of application of topical TXA in TKA. 3. Identify the potential advantages of topical TXA compared with intravenous TXA. 4. Recognize the possible differences between high-concentration and low-concentration topical TXA in reducing bleeding and transfusions in TKA. Intravenous tranexamic acid (TXA) has been identified to be effective in total knee arthroplasty (TKA), but the effect of topical application is still unclear. Therefore, the authors conducted a meta-analysis to assess the effect of topical TXA in TKA. Twelve trials with a total of 1179 knees were included. The results revealed that the application of topical TXA in TKA significantly reduced total blood loss by a mean of 280.65 mL and reduced transfusions without increasing the risks of deep venous thrombosis and pulmonary embolism. Topical TXA also reduced postoperative drain output by a mean of 194.59 mL and lowered postoperative hemoglobin drop by a mean of 0.66 g/dL. In addition, subgroup analysis showed that high-concentration TXA may be better at reducing bleeding and transfusions than low-concentration TXA. Therefore, the authors concluded that topical TXA can effectively reduce bleeding and transfusion rate in TKA without increasing the risk of deep venous thrombosis and pulmonary embolism, and high-concentration (20 mg/mL or more) topical TXA is recommended. [ Orthopedics. 2015; 38(5):315–324.]