Strong evidence supports that, in patients with no known contraindications, treatment with tranexamic acid decreases postoperative blood loss and reduces the necessity of postoperative transfusions following total knee arthroplasty (TKA).

Rationale
Eight high quality studies (Antinolfi, 2013, Charoencholvanich, 2011, Gautam, 2011, Good, 2003,Ishida, 2011,Roy, 2012, Sa-Ngasoongsong, 2013, Sarzaeem, 2014, Pachauri, 2014) were reviewed to assess the impact of tranexamic acid administration on blood loss and transfusion rates post total knee arthroplasty. There was significant variability in dosing, route of administration, and timing of administration; when assessed collectively, however, the use of tranexamic acid did show improvement in blood loss related outcomes.
 
Using six of the high quality studies a meta-analysis was performed on rate of blood transfusions which demonstrated a 52% reduction in patients receiving tranexamic acid (Figure 1). Three high quality studies demonstrated an improvement in Hgb. One high quality study (Ishida 2011) demonstrated a reduction in swelling and one high quality (Sa-Ngasoongsong 2013) study found an improvement in WOMAC function scores out to 1 year.
 
  1. Antinolfi,P., Innocenti,B., Caraffa,A., Peretti,G., Cerulli,G. Post-operative blood loss in total knee arthroplasty: knee flexion versus pharmacological techniques. Knee Surg Sports Traumatol.Arthrosc. 2013/9/29; 0: -
  2. Charoencholvanich,K., Siriwattanasakul,P. Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res. 2011/10; 10: 2874-2880
  3. Gautam,P.L., Katyal,S., Yamin,M., Singh,A. Effect of tranexamic acid on blood loss and transfusion requirement in total knee replacement in the Indian population: A case series. Indian Journal of Anaesthesia 2011; 6: 590-593
  4. Good,L., Peterson,E., Lisander,B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003/5; 5: 596-599
  5. Ishida,K., Tsumura,N., Kitagawa,A., Hamamura,S., Fukuda,K., Dogaki,Y., Kubo,S., Matsumoto,T., Matsushita,T., Chin,T., Iguchi,T., Kurosaka,M., Kuroda,R. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int.Orthop 2011/11; 11: 1639-1645
  6. Pachauri,A., Acharya,K.K., Tiwari,A.K. The effect of tranexamic acid on hemoglobin levels during total knee arthroplasty. Am.J.Ther. 2014; 5: 366-370
  7. Roy,S.P., Tanki,U.F., Dutta,A., Jain,S.K., Nagi,O.N. Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol.Arthrosc. 2012/12; 12: 2494-2501
  8. Sa-Ngasoongsong,P., Wongsak,S., Chanplakorn,P., Woratanarat,P., Wechmongkolgorn,S., Wibulpolprasert,B., Mulpruek,P., Kawinwonggowit,V. Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; A prospective triple-blinded randomized controlled trial. BMC Musculoskeletal Disorders 2013; 340: -
  9. Sarzaeem,M.M., Razi,M., Kazemian,G., Moghaddam,M.E., Rasi,A.M., Karimi,M. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty. J.Arthroplasty 2014/8; 8: 1521-1524