Evaluation of Intravenous Tranexamic Acid for Reduction of Perioperative Blood Loss and Transfusion Requirements in Total Knee Arthroplasty: A Prospective Randomized Double-Blind Study

Background: Total knee arthroplasty (TKA) is frequently associated with significant perioperative blood loss and increased transfusion requirements. Tranexamic acid (TXA), an antifibrinolytic agent, may reduce these risks. Material and Methods: A prospective, randomized, double-blind controlled trial was conducted at MIOT Hospitals, Chennai, between July 2015 and September 2016. Sixty patients undergoing unilateral primary cemented TKA were randomized into two groups: Group A received intravenous TXA (10 mg/kg before tourniquet deflation followed by 1 mg/kg/hour infusion for 12 hours), while Group B received placebo (normal saline). Outcomes assessed included perioperative blood loss, transfusion requirements, and changes in haemoglobin and haematocrit. Results: TXA significantly reduced postoperative blood loss compared to placebo (379.17 ± 174.44 mL vs 513.33 ± 143.89 mL; p=0.002). Total blood loss was also lower in the TXA group (543.30 ± 184.85 mL vs 685.83 ± 176.74 mL; p=0.003). The mean decline in haemoglobin and haematocrit was significantly less in the TXA group (1.53 ± 0.52 g/dL vs 2.14 ± 0.71 g/dL; 4.41 ± 1.54% vs 6.32 ± 1.93%; p=0.001). Blood transfusions were required in 20% of TXA patients compared to 50% in the placebo group (p=0.03). No serious complications, including thromboembolic events, were observed. Conclusion: Intravenous TXA effectively reduces perioperative blood loss and transfusion requirements in TKA without increasing complications. It may be considered a safe, efficient, and economical blood conservation strategy in knee replacement surgery. Keywords: Antifibrinolytic therapy, blood transfusion, knee replacement surgery, perioperative blood loss, total knee arthroplasty, tranexamic acid.