Optimal Management of Bleeding and Thrombosis in Total Knee Arthroplasty: Tranexamic Acid With Acetylsalicylic Acid or Low-Molecular-Weight Heparin.

Objective This study compared the efficacy and safety of combining tranexamic acid, which reduces bleeding, with acetylsalicylic acid (ASA) or low-molecular-weight heparin (LMWH), which is used for venous thromboembolism (VTE) prophylaxis in patients undergoing total knee arthroplasty (TKA). Materials and methods A retrospective analysis was conducted on 86 patients who underwent primary unilateral TKA between 2014 and 2020. Patients were divided into Group 1 (intravenous tranexamic acid (TA) + acetylsalicylic acid) and Group 2 (intravenous tranexamic acid + low-molecular-weight heparin). Demographic data, perioperative blood loss, transfusion requirements, and complications were recorded and analyzed. Results Group 1 showed significantly lower total blood loss (TBL), drainage volume, and transfusion rates than Group 2. No significant differences were observed in hidden blood loss (HBL) or maximum hemoglobin drop between the groups. Postoperative complications, including VTE, wound issues, and systemic adverse events, were comparable between the two groups. The length of hospital stay was shorter in Group 1. Conclusion The combination of TA with ASA demonstrated superior outcomes in blood conservation and transfusion rates compared to TA with LMWH, with no increase in postoperative complications. These findings suggest that ASA is a safe and effective option for VTE prophylaxis in TKA patients when used with TA.