Timing of Intraoperative Tranexamic Acid Use in Patients Undergoing Total Knee Arthroplasty: Before or After Tourniquet Application?

Abstract

Aim: Total knee arthroplasty is a good choice for effective treatment of end stage knee diseases. However, there is a considerable blood loss in intraoperative and postoperative periods. The aim of our study is to compare effectiveness of the use of single dose tranexamic acid on blood loss and transfusion need at before tourniquet inflation and after tourniquet deflation. Material and Methods: 90 patients who underwent total knee arthroplasty surgery by the same surgical team between April 2023 and July 2025 in the Orthopedics and Traumatology Department of Kocaeli City Hospital were retrospectively evaluated. Patients were divided to three groups; control group which tranexamic acid wasn’t administrated (group 1), before tourniquet group which tranexamic acid (TEA) was administrated before inflation of tourniquet (group 2) and after tourniquet group which tranexamic acid was administrated after deflation of tourniquet (group 3). Blood loss at 30th. minute and after 24 hours in the hemovac drain, change of hemoglobin (Hb), activated partial thromboplastine time (aPTT), partial thromboplastine time (PTZ) and international normalized ratio (INR) levels, need of transfusion were evaluated. Results: Blood loss, decrease on Hb levels and the need of transfusion at TEA administrated groups were found significantly less than control group. When compared two groups TEA administrated, blood loss was found significantly less in after tourniquet group than in before tourniquet group. It was found that there was not a significant change at aPTT, PTZ and INR levels in TEA administrated groups. Conclusion: Eventually single dose TEA administration after tourniquet lowers blood loss better than administration before tourniquet, but does no significant difference in Hb levels.

Keywords

• Tranexamic acid
• total knee arthroplasty
• hemostasis
• complication.

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