Tranexamic Acid in Hip and Knee Arthroplasty

J Am Acad Orthop Surg. 2015 Dec;23(12):732-40. doi: 10.5435/JAAOS-D-14-00223. Epub 2015 Oct 22.


Perioperative blood loss is a significant concern for patients undergoing total joint arthroplasty. A growing body of evidence has shown tranexamic acid (TXA) to be effective in decreasing perioperative blood loss and transfusion requirements in both primary and revision hip and knee arthroplasty. TXA is a synthetic drug that limits blood loss through inhibition of fibrinolysis and clot degradation. Both topical and intravenous administration of TXA, in a variety of dosing regimens, has proven effective. Further investigation is required to determine the optimal dose and dosing regimens; however, evidence exists to recommend an initial intravenous dose be given before beginning the procedure, with at least one additional intravenous dose administered postoperatively. Additionally, topical TXA doses >2 g appear to be more efficacious than lower doses. Finally, relatively few adverse reactions have been reported in arthroplasty patients, and no study to date has demonstrated an increased risk of symptomatic venous thromboembolic events in this patient population.

Keywords: Tranexamic acid; hip arthroplasty; knee arthroplasty.

Publication types

  • Review

MeSH terms

  • Antifibrinolytic Agents / administration & dosage
  • Antifibrinolytic Agents / economics
  • Antifibrinolytic Agents / therapeutic use*
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Blood Loss, Surgical / prevention & control*
  • Blood Transfusion
  • Humans
  • Postoperative Hemorrhage / prevention & control*
  • Tranexamic Acid / administration & dosage
  • Tranexamic Acid / economics
  • Tranexamic Acid / therapeutic use*
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control


  • Antifibrinolytic Agents
  • Tranexamic Acid