Using intra-articular tranexamic acid in total knee replacement surgery with and without bleeding control: a prospective randomized double blind study

OBJECTIVE: To investigate the effectiveness of tranexamic acid (TA) application in two techniques: in the first one wound closure is performed before the tourniquet is released; in the second one, wound closure is performed after the tourniquet is released. PATIENTS AND METHODS: The study is conducted on four groups of patients: (1) TA + TNR (tourniquet not released) where there is no bleeding control and TA is applied after wound closure without tourniquet release; (2) TA - TNR where placebo is applied after wound closure without tourniquet release; (3) TA + TR (tourniquet released) where tourniquet is released first and TA is applied after bleeding control and wound closure; and (4) TA - TR where tourniquet release is followed by bleeding control and placebo application. RESULTS: The amount of hemorrhage in hemovac drains in each group was as follows: 217.4 +/- 99.6 (100-590) ml in the TA + TNR group; 411.6 +/- 133.7 (175-850) ml in the TA - TNR group; 291.2 +/- 89.5 (160-650) ml in the TA + TR group; and 458.2 +/- 138.6 (200-920) ml in the TA - TR group (p<0.0001). The TA + TNR group differed significantly from other groups in terms of the hemorrhage in drains. Similarly, the TA + TNR group was notably different from the TA - TNR and TA - TR groups with regard to the hemoglobin and hematocrit values. CONCLUSIONS: The study reveals that the amount of blood in hemovac drains is reduced significantly after the application of tranexamic acid to the suprapatellar space in the technique where wound closure is performed without bleeding control and before the tourniquet is released.