Tranexamic acid TXA

  • Tranexamic acid (TXA) is a synthetic derivative of the amino acid lysine.  It is a competitive inhibitor of plasminogen activation.  Tranexamic acid decreases postoperative bleeding by acting on the fibrinolytic system.
  • 20mg/kg as a single dose before hip incision or tourniquet deflation in TKAs
  • 1 gm IV 20 min preop
  • 10 to 20 mg/kg IV of tranexamic acid thirty minutes before deflation of the tourniquet, followed by 10 to 15 mg/kg every three to eight hours for twenty-four hours or once a day for three days, appears to be a safe and effective method. Another feasible method is the intra-articular injection of 50 mg/kg once postoperatively. (Yang ZG, JBJS 2012;94A:1153)
  • Topical intra-articular tranexamic acid reduces blood loss in THA and TKA without adverse effects.  1g Tranexamic acid in 50ml saline solution. (Alshryda S, JBJS 2013;95:1961, Alshryda S, JBJS 2013;95:1969)
  • Combined IV and topical TXA is relatively more effective in controlling bleeding than either is individually.  (Sun Q, BMJ Open 2019;9:e024350)
  • Meta-analysis on tranexamic acid in TKA demonstrated significant reductions is blood loss and number of blood transfusions with no difference in DVT or PE rates.  (Yang ZG, JBJS 2012;94A:1153).
  • TXA use in trauma patients necessitating massive transfusions is associated with  lower mortality. (Boffard KD,  J Trauma. 2005 Jul;59(1):8-15;PubMed PMID: 16096533)

Tranexamic Acid References

  • J Am Acad Orthop Surg, Vol 18, No 3, March 2010, 132-138.
  • Yamasaki S, Masuhara K, Fuji T: Tranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty. J Bone Joint Surg Am 2005; 87:766-770. [Abstract/Free Full Text]
  • Husted H, Blond L, Sonne-Holm S, Holm G, Jacobsen T, Gebhur P: Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty: A prospective randomized double-blind study in 40 patients. Acta Orthop Scand 2003; 74:665-669. [Web of Science][Medline]
  • Johansson T, Pettersson LG, Lisander B: Tranexamic acid in total hip arthroplasty saves blood and money: A randomized, double-blind study in 100 patients. Acta Orthop 2005; 76:314-
  • Ralley CORR 2010:468, No. 7, July 2010:1905-1911
  • Yang ZG, JBJS 2012;94A:1153
  • Alshryda S, JBJS 2013;95:1961
  • Alshryda S, JBJS 2013;95:1969