Intra-articular versus intravenous tranexamic acid in primary total knee replacement

We commend Gomez-Barrena E et al. on their recent study entitled “Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial”. The study was well-designed and appropriate statistical analysis was performed. They compared 39 patients who received 3 grams of intraarticular tranexamic acid (TXA) with another 39 patients who had two doses of 15 milligrams/kilogram of intravenous TXA (one dose before tourniquet release and another three hours after surgery). There was zero incidence of blood transfusion. The visible blood loss as measured in the drain output at 24 hours postoperatively and the invisible blood loss estimated using the Nadler formula at 48 hours postoperatively were comparable in both groups of patients. They conclude that intra-articular TXA according to their described protocol demonstrated noninferiority when compared with intravenous TXA (1).