Tranexamic Acid
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).
Surgical Management of Osteoarthritis of the Knee
Endorsed by: The Knee Society, SOMOS, AAHKS, ACR, AGS, AANA

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.
 

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