Potentials of tranexamic acid injection to reduce bleeding in patients of total knee replacement procedure


Background: The high number of patients with knee osteoarthritis causes an increasingly frequent arthroplasty. This surgical procedure of Total Knee Replacement poses a risk of massive bleeding, which can affect albumin levels and cause intra-compartmental pressure on the nerves. Objective: This study aims to determine the effect of tranexamic acid injection on total blood loss, the degree of pain, and the need for blood transfusions after surgery in patients undergoing the procedure for Total Knee Replacement. Method: The study was an experimental research using primary data from laboratory examination obtained before and after surgery in 64 patients of Total Knee Replacement surgery in the ER operating theater of Dr. Soetomo Regional Public Hospital, Surabaya. Result: In the group receiving tranexamic acid, the group with 32 people (100%) reported a low postoperative VAS score, and did not require blood and albumin transfusions. In the group not receiving tranexamic acid, 32 people (100%) had a moderate postoperative VAS score, where four people (12.5%) required blood transfusions, and three people (9.4%) required albumin transfusions. Conclusion: The administration of tranexamic acid reduce total blood loss, the degree of pain, and reduce the need for blood transfusions after total knee replacement surgery.


  • Breugem, S. J. M., & Haverkamp, D. (2014). Anterior knee pain after a total knee arthroplasty: what can cause this pain?. World journal of orthopedics, 5(3), 163.
  • Crash-2 Collaborators. (2011). The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. The Lancet, 377(9771), 1096-1101.
  • Dang, P. P., & Schwarzkopf, R. (2013). Tranexamic acid and total knee arthroplasty. Ann Orthop Rheumatol, 1(1), 1001.
  • De-jie, F., Cheng, C., Lin, G., & Liu, Y. (2013). Use of intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. Chinese Journal of Traumatology, 16(2), 67-76.
  • Ganvir, S.D. Z.B.(2013). Prevalence and Identification of Risk Factors for Knee Osteoarthritis among Elderly Men and Women. Sch J Apllied Med Sci. 1(6):700–3.
  • Goyal, R., & Sardana, V. (2020). Labile Hemoglobin - A Biochemical Entity. Journal of Clinical and Experimental Investigations, 11(1), em00732.
  • Henry, D. A., Carless, P. A., Moxey, A. J., O’Connell, D., Stokes, B. J., Fergusson, D. A., & Ker, K. (2011). Anti‐fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane database of systematic reviews, (3).
  • Isbagio, H. (2004). Factors affecting radiographic progression of knee osteoarthritis. Age (years), 91(59.68), 8-03.
  • Nugraha, D. A., Haryadi, R. D., & Cahyono, S. (2019). Direct effect of short wave diathermy therapy and exercise with quadriceps bench against knee osteoarthritis patients with functional capabilities. JPhCS, 1146(1), 012013.
  • Pabinger, I., Fries, D., Schöchl, H., Streif, W., & Toller, W. (2017). Tranexamic acid for treatment and prophylaxis of bleeding and hyperfibrinolysis. Wiener klinische Wochenschrift, 129(9-10), 303-316
  • Prasad, N., Padmanabhan, V., & Mullaji, A. (2007). Blood loss in total knee arthroplasty: an analysis of risk factors. International orthopaedics, 31(1), 39-44.
  • Tamiru, S., Tesfaye, K., & Mamo, G. (2015). Analysis of Rainfall and Temperature Variability to Guide Sorghum (Sorghum Bicolar) Production in Miesso Areas, Eastern Ethiopia. International Journal of Sustainable Agricultural Research, 2(1), 1-11.
  • Triyudanto, A. N., & Lubis, A. M. (2016). The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty. Medical Journal of Indonesia, 25(4), 234-9.
  • Utomo, D. N., Mahyudin, F., Wijaya, A. M., & Widhiyanto, L. (2018). Proximal fibula osteotomy as an alternative to TKA and HTO in late-stage varus type of knee osteoarthritis. Journal of orthopaedics, 15(3), 858-861.
  • Utomo, D. N., Mahyudin, F., Yanuar, A., Widhiyanto, L., & Hernugrahanto, K. D. (2018). Correction of severe valgus deformity of knee osteoarthritis with non-constrained total knee arthroplasty implant: A case report. International journal of surgery case reports, 53, 218-222.
  • Winter, G. F. (2017). Tranexamic acid. British Journal of Midwifery, 25(9), 603-603.
  • Yang, Z. G., Chen, W. P., & Wu, L. D. (2012). Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. JBJS, 94(13), 1153-1159.


This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.