Topical intra articular tranexamic acid reduces packed blood cell consumption in total joint arthroplasty.

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Bibliographic Details
Title:	Topical intra articular tranexamic acid reduces packed blood cell consumption in total joint arthroplasty.
Alternate Title:	El ácido tranexámico intraarticular tópico reduce el consumo de glóbulos rojos concentrados en la artroplastía articular total.
Authors:	Fraind-Maya, G.¹ fraind29@gmail.com, Nasrawy, T.¹, Kandel, L.¹, Greenberg, A.¹, Liebergall, M.¹, Perets, I.¹, Laniado-Nahmad, D.¹, Rivkin, G.¹
Source:	Acta Ortopédica Mexicana. Jan/Feb2026, Vol. 40 Issue 1, p35-39. 5p.
Subjects:	TRANEXAMIC acid, ARTHROPLASTY, BLOOD transfusion, BLOOD loss estimation, TOTAL knee replacement, TOPICAL drug administration, THROMBOEMBOLISM, HEMOGLOBINS
Abstract (English):	Introduction: post-operative blood loss anemia is an undesired event following total joint arthroplasty. Use of tranexamic acid (TXA) has been shown to reduce blood loss after surgery and can be administered intravenously, orally and topically. We assessed the effect of topical intra articular TXA administration at the end of surgery in total joint arthroplasty on post-operative packed blood cell units’ consumption. Objective: assess the effect of topical intra-articular TXA administration in reduction of packed blood cell units’ consumption postoperatively. Material and methods: this is a retrospective study comparing two groups of patients that had either a primary total knee arthroplasty (TKA) or primary total hip arthroplasty (THA) during a four months’ period before and after the beginning of intra articular administration of a solution containing 2 grams of TXA. Pre-operative hemoglobin level, post-operative day one hemoglobin level, packed blood cell administration and venous thromboembolism events (VTE) were assessed. Results: a total of 282 patients were reviewed, 148 records of patients that had a TKA and 134 records of patients that had THA. There were 80 and 68 TKA without and with TXA administration, respectively. There were 84 and 50 THA without and with TXA administration, respectively. There was no difference between the groups with regard to preoperative anticoagulation and aspirin treatment and VTE risk assessment. There was also no difference regarding preoperative hemoglobin levels. Patients undergoing THA and TKA showed a significant decrease in the hemoglobin level between preoperative levels to hemoglobin on postoperative day. However, administration of TXA ameliorated this decrease in hemoglobin levels, from 2.77 to 2.18 g/dl in hip arthroplasty (p < 0.001) and from 2.92 to 1.72 g/dl in knee arthroplasty (p < 0.001). In the THA group 13 packed blood cell units were administered without TXA compared to two units in patients treated with TXA (p < 0.001). In the TKA group 15 packed blood cell units were administered without TXA compared to two units in patients treated with TXA (p < 0.001). There were no VTE events in the THA patients. In the TKA patients, pulmonary embolism was diagnosed in two patients not treated with TXA and in three patients that were treated with intra articular TXA (p = 0.66). Conclusion: intra-articular topical administration of TXA at the end of surgery significantly reduced need for post-operative packed blood cell units’ administration without increases in VTE risk in all patients undergoing primary THA and TKA. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Introducción: la anemia por pérdida de sangre postoperatoria es un evento no deseado tras una artroplastía articular total. Se ha demostrado que el uso de ácido tranexámico (TXA) reduce la pérdida de sangre tras la cirugía y puede administrarse por vía intravenosa, oral y tópica. Evaluamos el efecto de la administración tópica intraarticular de TXA al final de la cirugía en la artroplastía articular total sobre el consumo de las unidades de células sanguíneas empaquetadas postoperatorias. Objetivo: evaluar el efecto de la administración tópica intraarticular de TXA en la reducción del consumo de unidades de células sanguíneas empaquetadas tras la operación. Material y métodos: este es un estudio retrospectivo que compara dos grupos de pacientes que se sometieron a una artroplastía primaria total de rodilla (ATR) o una artroplastía primaria total de cadera (ATC) durante un período de cuatro meses antes y después del inicio de la administración intraarticular de una solución que contenía 2 gramos de TXA. Se evaluaron los niveles preoperatorios de hemoglobina, el nivel de hemoglobina del primer día postoperatorio, la administración de células sanguíneas empaquetadas y los eventos de tromboembolismo venoso (TEV). Resultados: se revisaron un total de 282 pacientes, 148 registros de pacientes con una ATR y 134 registros de pacientes con ATC. Había 80 y 68 ATR sin y con administración de TXA, respectivamente. Había 84 y 50 ATC sin y con administración de la TXA, respectivamente. No hubo diferencias entre los grupos en cuanto al tratamiento reoperatorio de anticoagulación y aspirina ni en la evaluación de riesgos de TEV. Tampoco hubo diferencia en los niveles de hemoglobina preoperatorios. Los pacientes sometidos a ATC y ATR mostraron una disminución significativa del nivel de hemoglobina entre los niveles preoperatorios y la hemoglobina en el día postoperatorio. Sin embargo, la administración de TXA mitigó esta disminución de los niveles de hemoglobina, pasando del 2.77 al 2.18 g/dl en la artroplastía de cadera (p < 0.001) y del 2.92 al 1.72 g/dl en la artroplastía de rodilla (p < 0.001). En el grupo de ATC se administraron 13 unidades de células sanguíneas empaquetadas sin TAX en comparación con dos unidades en pacientes tratados con TXA (p < 0.001). En el grupo ATR se administraron 15 unidades de células sanguíneas empaquetadas sin TXA, en comparación con dos unidades en pacientes tratados con TXA (p < 0.001). No hubo eventos de TEV en los pacientes con ATC. En los pacientes con ATR, se diagnosticó embolia pulmonar en dos pacientes no tratados con TXA y en tres pacientes tratados con TXA intraarticular (p = 0.66). Conclusión: la administración intraarticular tópica de TXA al final de la cirugía redujo significativamente la necesidad de administración de unidades de células sanguíneas empaquetadas postoperatorias sin aumentar el riesgo de TEV en todos los pacientes sometidos a ATC primaria y ATR. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Introduction: post-operative blood loss anemia is an undesired event following total joint arthroplasty. Use of tranexamic acid (TXA) has been shown to reduce blood loss after surgery and can be administered intravenously, orally and topically. We assessed the effect of topical intra articular TXA administration at the end of surgery in total joint arthroplasty on post-operative packed blood cell units’ consumption. Objective: assess the effect of topical intra-articular TXA administration in reduction of packed blood cell units’ consumption postoperatively. Material and methods: this is a retrospective study comparing two groups of patients that had either a primary total knee arthroplasty (TKA) or primary total hip arthroplasty (THA) during a four months’ period before and after the beginning of intra articular administration of a solution containing 2 grams of TXA. Pre-operative hemoglobin level, post-operative day one hemoglobin level, packed blood cell administration and venous thromboembolism events (VTE) were assessed. Results: a total of 282 patients were reviewed, 148 records of patients that had a TKA and 134 records of patients that had THA. There were 80 and 68 TKA without and with TXA administration, respectively. There were 84 and 50 THA without and with TXA administration, respectively. There was no difference between the groups with regard to preoperative anticoagulation and aspirin treatment and VTE risk assessment. There was also no difference regarding preoperative hemoglobin levels. Patients undergoing THA and TKA showed a significant decrease in the hemoglobin level between preoperative levels to hemoglobin on postoperative day. However, administration of TXA ameliorated this decrease in hemoglobin levels, from 2.77 to 2.18 g/dl in hip arthroplasty (p < 0.001) and from 2.92 to 1.72 g/dl in knee arthroplasty (p < 0.001). In the THA group 13 packed blood cell units were administered without TXA compared to two units in patients treated with TXA (p < 0.001). In the TKA group 15 packed blood cell units were administered without TXA compared to two units in patients treated with TXA (p < 0.001). There were no VTE events in the THA patients. In the TKA patients, pulmonary embolism was diagnosed in two patients not treated with TXA and in three patients that were treated with intra articular TXA (p = 0.66). Conclusion: intra-articular topical administration of TXA at the end of surgery significantly reduced need for post-operative packed blood cell units’ administration without increases in VTE risk in all patients undergoing primary THA and TKA. [ABSTRACT FROM AUTHOR]
ISSN:	23064102
DOI:	10.35366/122371