Timing of Administration
In primary TJA, administration of IV TXA before the incision potentially reduces blood loss and the need for transfusion compared to its administration after incision.
Tranexamic Acid in Total Joint Arthroplasty
Developed by the American Association of Hip and Knee Surgeons

Rationale
Direct meta-analysis investigating the affect on timing of TXA administration was available in five high quality studies.2,3 Due to a limited number of studies, direct metaanalysis was only performed for primary TKA.2,3 The result showed no significant difference between pre-incision and post-incision administration. However, trends towards significance were identified.3 Network meta-analysis for primary TKA demonstrated that a single dose of IV TXA before incision reduced the risk of transfusion compared to administration after incision; however, there was no significant difference regarding blood loss.3 In the setting of a primary THA, network meta-analysis failed to show any significant difference in blood loss or risk of transfusion between pre-incision and post-incision administration of TXA.2

Due to the inconsistency in the results of high quality studies, we are only able to provide “moderate” support to our recommendation. Despite the inconsistencies, we still recommend pre-incision TXA administration because the results demonstrate no potential benefit for post-incision administration. In contrast, pre-incision administration does demonstrate benefit in some of the analyses.

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