Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement - A prospective, randomised controlled trial

We performed a randomised, controlled trial involving 150 patients with a pre-operative level of haemoglobin of 13.0 g/dl or less, to compare the effect of either topical fibrin spray or intravenous tranexamic acid on blood loss after total knee replacement. A total of 50 patients in the topical fibrin spray group had 10 ml of the reconstituted product applied intra-operatively to the operation site. The 50 patients in the tranexamic acid group received 500 mg of tranexamic acid intravenously five minutes before deflation of the tourniquet and a repeat dose three hours later, and a control group of 50 patients received no pharmacological intervention. There was a significant reduction in the total calculated blood loss for those in the topical fibrin spray group ( p = 0.016) and tranexamic acid group ( p = 0.041) compared with the control group, with mean losses of 1190 ml ( 708 to 2067), 1225 ml ( 580 to 2027), and 1415 ml ( 801 to 2319), respectively. The reduction in blood loss in the topical fibrin spray group was not significantly different from that achieved in the tranexamic acid group ( p = 0.72).