Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1, Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China.
J Orthop Surg Res. 2021 Sep 3;16(1):546. doi: 10.1186/s13018-021-02685-y.
Tranexamic acid (TXA) has shown significant reductions in blood loss and transfusion rates in total knee arthroplasty (TKA). However, the optimal administration route continues to be debated. The aim of this trial was to compare the effectiveness of intravenous (IV) versus peri-articular injection (PAI) application of tranexamic acid in patients undergoing total knee arthroplasty.
We conducted a randomized controlled, double-blinded study. A total of 93 patients undergoing primary unilateral TKA were randomly distributed between 2 groups: the IV group (47 cases; 1 g TXA IV) and the PAI group (46 cases; 1 g TXA injected peri-articularly). The amount of total and hidden blood loss (HBL), drainage, transfusion rate, hemoglobin and hematocrit drift, and complications were recorded.
Peri-articular injection of TXA reduced total blood loss (P < 0.001) and HBL more than IV use of TXA (P < 0.001). No patients in either group received a transfusion. No symptomatic deep venous thrombosis or other severe complications occurred.
Peri-articular injection of TXA significantly reduced total blood loss and hidden blood loss to a greater degree than IV injection in total knee arthroplasty without reduction of drainage volume.
Chinese Clinical Trial Registry, ChiCTR-INR-16010270 . Date of registration: December 27, 2016.
氨甲环酸（TXA）已显示在全膝关节置换术（TKA）中显著减少失血和输血率。然而，最佳给药途径仍存在争议。本试验旨在比较静脉（IV）与关节周围注射（PAI）应用氨甲环酸在全膝关节置换术中的效果。
我们进行了一项随机对照、双盲研究。共 93 例接受单侧初次 TKA 的患者随机分为两组：IV 组（47 例；1g TXA IV）和 PAI 组（46 例；1g TXA 关节周围注射）。记录总失血量和隐匿性失血（HBL）量、引流、输血率、血红蛋白和血细胞比容漂移以及并发症。
关节周围注射 TXA 比静脉应用 TXA 减少总失血量（P<0.001）和 HBL（P<0.001）。两组均无患者输血。无症状深静脉血栓形成或其他严重并发症发生。
关节周围注射 TXA 可显著减少全膝关节置换术的总失血量和隐匿性失血量，而不减少引流体积，其程度大于静脉注射。
中国临床试验注册中心，ChiCTR-INR-16010270。注册日期：2016 年 12 月 27 日。
