Efficacy of combined use of intraarticular and intravenous tranexamic acid in total knee arthroplasty

Tranexamic acid (TXA) has come to light as an effective method to decrease blood loss and transfusion rates in total knee arthroplasty (TKA) without increasing the risk of thromboembolic events (TEE) (1). Many initial studies utilized intravenous (IV) TXA and more recently topical TXA has also been shown to be effective (2,3). In these studies, various dosing regimens have been used for both IV and topical TXA. Some have attempted to find the most beneficial regimen, demonstrating better results with two IV doses compared to a single IV dose (4,5). Others have compared various topical regimens to IV regimens, often comparing single topical doses to one or two IV doses (6-8). These have often shown similar results between IV and topical TXA; however, comparison is difficult due to variance in the regimens used (quantity of TXA, number of doses, route of topical administration). Our standard practice is to administer one gram IV prior to incision and one gram IV at initiation of closure. This provides an effective, easily reproducible routine for the entire surgical team.