Widespread of total knee arthroplasty perioperative blood management techniques based on tranexamic acid: barriers and opportunities

Current interest of orthopaedic surgeons in tranexamic acid (TXA) is rapidly increasing in the literature, and controversial issues, appropriately highlighted by intelligent and deep comments (1-3), deserve some reflections. Perioperative total knee replacement (TKR) clinical management has significantly improved in the last 10 years due to the widespread, highly effective and safe blood loss control with different protocols that incorporate the use of TXA. It is amazing how the rediscovery by the Orthopaedic community of an old medication (TXA has been in use during more than 50 years by different manufacturers under different commercial names such as Transamin, Cyclokapron, Amcha or Amchafibrin, for various indications related to non-orthopaedic bleeding) has transformed the perioperative management of orthopaedic elective procedures that involved significant postoperative bleeding such as total knee arthroplasty after tourniquet release. But besides the arthroplasty field, major benefits in the use of this medication have also been elicited in other areas of orthopaedics and traumatology that reinforce the interest in the drug and provide valuable experience. It is worth mentioning, among other fields of interest, the survivorship increase of severely traumatized patients with early TXA administration, a key aspect that became recognized by most prestigious opinion leaders and publications, not without controversy (4,5).