| Objective To evaluate the safety and efficacy of combined intravenous and topical administration of tranexamic acid (TXA) in reducing postoperative blood loss and alleviating inflammatory response in patients undergoing total knee arthroplasty (TKA), and to explore the optimal duration of TXA administration.Methods A retrospective study was conducted on 118 patients who underwent primary unilateral TKA from March 2023 to February 2024. Based on the protocol (enhanced recovery after surgery, ERAS) for TXA use, the patients were divided into group A (63 cases, received intravenous infusion of 1 g TXA 10 min before surgery, followed by intra-articular irrigation of 2 g TXA through drainage tube after completion of wound closure, with closure of the drainage tube. The drainage tube was opened 2 h later, followed by a second intravenous infusion of 1 g TXA after 2 h) and group B (55 cases, received intravenous infusion of 1 g TXA 10 min before surgery, followed by intra-articular irrigation of 2 g TXA through drainage tube after completion of wound closure, with drainage tube opened 2 h later. A second intravenous infusion of 1 g TXA was administered after 2 h and 6 h). The total blood loss, maximum decrease in hemoglobin, transfusion rate, albumin transfusion rate, fibrinolysis parameters, inflammatory parameters, venous thromboembolism, and complications were compared between the two groups.Results The average follow-up time was from 3 to 12 months, with an average of (6.12±3.14) months. The maximum decrease in hemoglobin and albumin transfusion rate in group B were significantly lower than those in the group A [(24.24±8.30) g/L vs (28.08±8.62) g/L, P<0.05; 1 case vs 8 cases, P<0.05]. The levels of fibrin degradation products and D-dimer at 24 h postoperatively in group B were significantly lower than those in group A [(5.45±2.78) mg/L vs (7.68±2.01) mg/L, P<0.05; (2.02±1.65) mg/L vs (3.64±1.78) mg/L, P<0.05], while no significant differences were found between the two groups at 8 h and 72 h postoperatively (P>0.05). There was no significant difference in the incidence of venous thromboembolism between the two groups postoperatively (P>0.05).Conclusion Local combined with intravenous administrations of TXA after unilateral TKA can further inhibit fibrinolysis, reduce the maximum decrease in hemoglobin, and decrease the albumin transfusion rate, without increasing the risk of venous thromboembolism. |
