Single dose intravenous tranexamic acid as effective as continuous infusion in primary total knee arthroplasty: a randomised clinical trial

Arch Orthop Trauma Surg. 2015 Apr;135(4):465-71. doi: 10.1007/s00402-015-2168-z. Epub 2015 Feb 10.


Introduction: A randomised, double-blind clinical trial was conducted comparing the efficacy of tranexamic acid (TXA) as a single intravenous bolus or a continuous infusion to patients undergoing total knee arthroplasty (TKA). Study hypothesis was that a second dose of TXA would not offer any clinical benefits over the single infusion.

Materials and methods: One hundred and six patients were randomised to a single intraoperative dose of 30 mg/kg tranexamic acid (OS group, n = 54), or to a loading dose of 10 mg/kg tranexamic acid followed 2 h later by a continuous 2 mg/kg/h infusion for 20 h (OD group, n = 52). The primary outcome was blood loss calculated from haematological values and perioperative transfusions. Secondary outcomes included the occurrence of major complications within the first postoperative year.

Results: All patients completed tranexamic acid therapy without adverse events. The mean blood loss was 1,148 ± 585 ml in group OS and 1,196 ± 614 ml in group OD (p = 0.68). No patients received a transfusion. There were no occurrences of major complications up to 6-weeks follow-up.

Conclusions: The study demonstrated that a single bolus of tranexamic acid 30 mg/kg is as effective as a continuous infusion in patients undergoing tranexamic acid. The single application of tranexamic acid as part of routine care is recommended.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antifibrinolytic Agents / administration & dosage
  • Arthroplasty, Replacement, Knee*
  • Blood Transfusion
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Female
  • Humans
  • Infusions, Intravenous
  • Intraoperative Care / methods*
  • Intraoperative Complications / prevention & control*
  • Male
  • Osteoarthritis, Knee / surgery*
  • Postoperative Period
  • Thrombosis / prevention & control*
  • Tranexamic Acid / administration & dosage*
  • Treatment Outcome


  • Antifibrinolytic Agents
  • Tranexamic Acid