Effect of Topical Tranexamic Acid in Reducing Bleeding and Transfusions in TKA
Chen Yue, MD; Fuxing Pei, MD; Peiqing Yang, MD; Jinwei Xie, MD; Pengde Kang, MD
Support Statement: There is no commercial support for this activity.
As a result of reading this article, physicians should be able to:
1. Recognize the efficacy and safety of topical tranexamic acid (TXA) for reducing bleeding and transfusions in total knee arthroplasty (TKA).
2. Describe the main methods of application of topical TXA in TKA.
3. Identify the potential advantages of topical TXA compared with intravenous TXA.
Reviewer names: Robert D. D’Ambrosia, MD, Editor-in-Chief, Orthopedics; Albert Aboulafia, MD, CME Editor, Orthopedics
Faculty members report the following financial relationships:
Robert D. D’Ambrosia, MD, has no relevant financial relationships to disclose.
Albert Aboulafia, MD, has no relevant financial relationships to disclose.
The authors have no relevant financial relationships to disclose.
The staff of Keck School of Medicine of USC and Orthopedics have no relevant financial relationships to disclose.
Signed disclosures are on file at Keck School of Medicine of USC.
Credit designation: The Keck School of Medicine of USC designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Release date: May 1, 2015.
Expiration date: June 1, 2018.
How to participate: To participate in this CME activity, you must read the educational objectives, log-in to www.Healio.com, pay for the activity ($20.00), answer the pretest questions, read the article[s], complete the CME posttest, and complete the evaluation. Provide only one (1) correct answer for each question. A satisfactory score is defined as answering 80% of the posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, you will receive a certificate by email, issued by Keck School of Medicine of USC, for 1 AMA PRA Category 1 Credit™.
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Target audience: This CME activity is primarily targeted to orthopedic surgeons, hand surgeons, head and neck surgeons, trauma surgeons, physical medicine specialists, and rheumatologists. There is no specific background requirement for participants taking this activity.
Unlabeled and investigational usage statement: The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage.
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Intravenous tranexamic acid (TXA) has been identified to be effective in total knee arthroplasty (TKA), but the effect of topical application is still unclear. Therefore, the authors conducted a meta-analysis to assess the effect of topical TXA in TKA. Twelve trials with a total of 1179 knees were included. The results revealed that the application of topical TXA in TKA significantly reduced total blood loss by a mean of 280.65 mL and reduced transfusions without increasing the risks of deep venous thrombosis and pulmonary embolism. Topical TXA also reduced postoperative drain output by a mean of 194.59 mL and lowered postoperative hemoglobin drop by a mean of 0.66 g/dL. In addition, subgroup analysis showed that high-concentration TXA may be better at reducing bleeding and transfusions than low-concentration TXA. Therefore, the authors concluded that topical TXA can effectively reduce bleeding and transfusion rate in TKA without increasing the risk of deep venous thrombosis and pulmonary embolism, and high-concentration (20 mg/mL or more) topical TXA is recommended.