Abstract
Blood loss management is critical to positive outcomes in patients undergoing total
knee arthroplasty (TKA). Transfusions are associated with an increased risk of major
and minor adverse events, length of hospitalization, and overall cost associated with
surgery. Many techniques have been investigated and compared. Tranexamic acid (TXA),
an antifibrinolytic drug widely known to reduce blood loss, may be a bridge to the
goal of eliminating blood transfusions from TKA. Administration of TXA can be performed
intravenously, topically at the knee joint, orally, or in combination. A single bolus
or multiple doses have reduced total blood loss and transfusion rates consistently,
safely, and cost-effectively. The uptake in use of TXA by surgeons has been slow due
to concerns in patients deemed high risk for thromboembolic events. Newer evidence
from studies specifically involving high-risk patients demonstrates that TXA is indeed
safe in this cohort and provides benefits that greatly outweigh potential risks. Incorporation
of TXA as a routine part of TKA is in the best interest of patients, health care teams,
and medical institutions. TXA can be employed seamlessly with other blood saving techniques
and has the capacity to increase productivity and decrease overall cost. This can
be achieved by reducing the incidence of transfusion and length of stay, and the need
for practices such as preoperative anemia treatment and suction drainage.
Keywords
total knee arthroplasty - tranexamic acid - blood management - transfusion
