Comparison of weight-based versus standard dosing of tranexamic acid for blood loss and transfusion amount in knee arthroplasty without tourniquet


Knee arthroplasty; tranexamic acid; standard dosing; weight-based dosing; blood loss; transfusion

Published online: May 03 2022

Olcay Guler, Engin Çarkcı, Mehmet Halis Çerci, Gürkan Gümüşsuyu, Çağatay Öztürk

From the Department of Orthopedics and Traumatology, Arel University, Medical Faculty, Istanbul, Turkey


The aim of the study is to compare weight-based versus standard dosing of intravenous (IV) tranexamic acid (TXA) for blood loss and transfusion amount in total knee arthroplasty (TKA) without a tourniquet.

A total of 99 patients were divided into two groups: Group 1 (standard): 1 g of IV TXA 30 min before skin incision, and 1 g at postoperative 30 min and 3 h. Group 2 (weight-based): 10 mg/kg IV TXA 30 min before the skin incision, and 10 mg/kg at postoperative 30 min, and 3 h. Hemoglobin levels, before, and 1, and 2 days after the operation, postoperative amount of decrease in hemoglobin levels, and amount of erythrocyte transfusion were recorded. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were applied in the evaluation of TKA results preoperatively, and at 1., 3., 6., and 12. months, postoperatively.

In both study groups, hemoglobin levels in male patients dropped significantly more deeply than female patients. Also, in both study groups, hemo- globin levels were significantly lower in patients with comorbid illnesses. A statistically significant difference was not detected between both groups in terms of pre- and postoperative WOMAC scores, KSS knee scores, and KSS function scores.

Our study showed that standard and weight-based dosing of IV TXA treatments were similar in efficacy and safety. Both treatments reduce blood loss and the need for transfusion. Also, there was no significant difference in terms of reliability between two groups.