Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study

J Arthroplasty. 2014 Aug;29(8):1528-31. doi: 10.1016/j.arth.2014.03.011. Epub 2014 Mar 21.


The purpose of this study was to compare the efficacy of topical Tranexamic Acid (TXA) versus Intravenous (IV) Tranexamic Acid for reduction of blood loss following primary total knee arthroplasty (TKA). This prospective randomized study involved 89 patients comparing topical administration of 2.0g TXA, versus IV administration of 10mg/kg. There were no differences between the two groups with regard to patient demographics or perioperative function. The primary outcome measure, perioperative change in hemoglobin level, showed a decrease of 3.06 ± 1.02 in the IV group and 3.42 ± 1.07 in the topical group (P = 0.108). There were no statistical differences between the groups in preoperative hemoglobin level, lowest postoperative hemoglobin level, or total drain output. One patient in the topical group required blood transfusion (P = 0.342). Based on our study, topical Tranexamic Acid has similar efficacy to IV Tranexamic Acid for TKA patients.

Keywords: TKA; TXA; intravenous tranexamic acid; prospective randomized study; topical tranexamic acid; total knee arthroplasty.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Aged
  • Aged, 80 and over
  • Antifibrinolytic Agents / administration & dosage*
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Blood Loss, Surgical / prevention & control*
  • Blood Transfusion
  • Drainage
  • Female
  • Hemoglobins / metabolism
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / prevention & control*
  • Prospective Studies
  • Tranexamic Acid / administration & dosage*


  • Antifibrinolytic Agents
  • Hemoglobins
  • Tranexamic Acid