Safety and efficacy of topical tranexamic acid over intravenous tranexamic acid in reducing blood loss and transfusion rates in hip and knee arthroplasty

Background: Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss. Hence the present study was undertaken to compare the efficacy of topical TXA and intravenous (IV) TXA in reducing blood loss and transfusion rate in primary total hip and total knee arthroplasty.Methods: Total of 31 cases undergoing either primary THA (23 cases) or TKA (8 cases) during a study period from June were enrolled. Outcome measures were drained output, transfusion rate, drop in haemoglobin (Hb) and blood loss measured by Nadler et al formula.Results: In THR group, 12 (52.17%) cases and in TKA group, 3 (37.5%) cases were managed using IV TXA whereas 11 (47.82%) and 5 (62.5%) cases were managed using topical TXA in THR and TKR group respectively. The mean drain output was greater among IV TKR group (261.66±129.60 ml) as compared to topical TKR group (210±129.49 ml). In THR drain output in IV group was 216±104.08 ml. In both the groups, mean blood loss was lower in cases where IV TXA was administered as compared to topical TXA, (p>0.05). The mean drop in Hb was greater after topical administration of TXA in both the groups as compared to IV administered TXA. In THR group, 9 (39.13%) patients required blood transfusion. In sickle cell disease patients, we found more blood loss and drain output as compared to non-sickle cell disease (SCD) patients.Conclusions: Both IV and topical TXA are clinically effective and safe in decreasing calculated blood loss, Hb drop after THA and TKA. 