Topical tranexamic acid reduces blood loss in minimally invasive total knee arthroplasty receiving rivaroxaban

Background. It is unclear whether topical (intra-Articular) or intravenous TXA reduces blood loss in minimally invasive TKA patients receiving a direct oral anticoagulant for thromboprophylaxis. This study is to investigate whether TXA given intravenously or intra-Articularly is effective in reducing blood loss in minimally invasive TKA patients using rivaroxaban for thromboprophylaxis. Methods. Ninety-Three patients who underwent primary minimally invasive TKA were divided into placebo group (30 patients) that received saline both intravenously and intra-Articularly, intravenous (IV) group (31 patients) that received 1 g TXA intravenously, and topical group (32 patients) that received 3 g TXA in 100 ml saline intra-Articularly. All patients received oral rivaroxaban of 10 mg daily for 14 days postoperatively. Results. p<0.001 and p=0.041. The mean total blood loss was 1131 mL (567-1845) in placebo, which was higher than that in the IV group (921 mL; range, 465-1495; p=0.014) and the topical group (795 mL; range, 336-1350; p<0.001). The total blood loss did not differ between the IV and the topical group (p=0.179). Conclusion. This prospective, randomized, controlled trial demonstrated an equal efficacy of TXA in blood conservation when administered intravenously or topically in minimally invasive TKA patients receiving rivaroxaban for thromboprophylaxis.