Topical Administration of Tranexamic Acid Plus Diluted-Epinephrine in Primary Total Knee Arthroplasty: A Randomized Double-Blinded Controlled Trial

J Arthroplasty. 2015 Aug;30(8):1354-8. doi: 10.1016/j.arth.2015.03.003. Epub 2015 Mar 14.


The aim of this trial was to evaluate the efficacy and safety of intra-articular administration of tranexamic acid (TXA) plus diluted-epinephrine (DEP) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty (TKA) without drainage. One hundred patients scheduled to undergo TKA were randomized into two groups: 50 patients received intra-articular 3g TXA plus 0.25mg DEP (1:200,000), and 50 patients received 3g topical TXA alone. The results showed that topical combined administration significantly reduced total blood loss (P=0.006), hidden blood loss (P=0.000) and transfusion rate (0% vs. 4%), without increasing the risk of thromboembolic and hemodynamic complications (P>0.05). Therefore, topical TXA plus DEP was effective and safe in reducing blood loss and transfusion following TKA, without substantial complications.

Keywords: TKA; blood loss; epinephrine; topical; tranexamic acid; transfusion.

Publication types

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

MeSH terms

  • Administration, Topical
  • Aged
  • Antifibrinolytic Agents / administration & dosage*
  • Arthroplasty, Replacement, Knee / methods*
  • Double-Blind Method
  • Drainage / adverse effects
  • Epinephrine / administration & dosage*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Perioperative Period
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / prevention & control*
  • Risk
  • Thromboembolism / prevention & control
  • Time Factors
  • Tranexamic Acid / administration & dosage*
  • Transfusion Reaction


  • Antifibrinolytic Agents
  • Tranexamic Acid
  • Epinephrine