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).

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.
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  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
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  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
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  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
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  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