Dergiler / Kafkas Journal of Medical Sciences / 2026 / Cilt: 16 Sayı: 2

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

Ahmet Volkan Doğan(University of Health Science Kocaeli City Hospital, Orthopedics and Traumatology Clinic)
Tuncay Baran(University of Health Science Kocaeli City Hospital, Orthopedics and Traumatology Clinic)
Ümit Gök(University of Health Science Kocaeli City Hospital, Orthopedics and Traumatology Clinic)
Mümin Karahan(Kafkas University Faculty Of Medicine, Orthopedics And Traumatology Clinic)
Erdinç Esen(Gazi University Faculty Of Medicine, Orthopedics And Traumatology Clinic)
Sayfa
152–157
Yayın Tarihi
2026-08-06
DOI
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⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Conclusion: Eventually single dose TEA administration after tourniquet lowers blood loss better than administration before tourniquet, but does no significant difference in Hb levels.

📌 3 Maddede Bu Makale

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Amaç & Hipotez:Aim: Total knee arthroplasty is a good choice for effective treatment of end stage knee diseases.
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Temel Bulgular & Veri: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.
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Sonuç & Katkı:Conclusion: Eventually single dose TEA administration after tourniquet lowers blood loss better than administration before tourniquet, but does no significant difference in Hb levels.
🔬Tür:Araştırma Makalesi
📍Kapsam:2023 Verileri
⚙️Değişkenler:Tranexamic acid · total knee arthroplasty · hemostasis

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.

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Bu Makaleye Atıf Yap

Doğan, A. V., Baran, T., Gök, Ü., Karahan, M., Esen, E. (2026). Timing of Intraoperative Tranexamic Acid Use in Patients Undergoing Total Knee Arthroplasty: Before or After Tourniquet Application?. Kafkas Journal of Medical Sciences, Cilt: 16 Sayı: 2, 152–157. https://ajindex.com/articles/1631463

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Kaynakça (22)

  1. Liao L, Chen Y, Tang Q, Chen YY, Wang WC. Tranexamic acid plus drain-clamping can reduce blood loss in total knee arthroplasty: a systematic review and meta-analysis. Int J Surg. 2018;52:334–341. https://doi.org/10.1016/j.ijsu.2018.01.040
  2. Hill J, Magill P, Dorman A, Hogg R, Eggleton A, Benson G, et al. Assessment of the effect of addition of 24 hours of oral tranexamic acid post-operatively to a single intraoperative intravenous dose of tranexamic acid on calculated blood loss following primary hip and knee arthroplasty (TRAC-24): a study protocol for a randomised controlled trial. Trials. 2018;31;19(1):413. https://doi.org/10.1186/s13063-018-2784-3
  3. Cavuşoglu AT, Ayanoglu T, Esen E, Atalar H, Turanlı S. Is intraarticular administration of tranexamic acid efficient and safe as systemic administration in total knee arthroplasty? Single center, randomized, controlled trial. Eklem Hastalik Cerrahisi. 2015;26:164–167. https://doi.org/10.5606/ehc.2015.33
  4. OS Atik. Does tranexamic acid reduce blood loss and blood transfusion requirement in knee arthroplasty? Eklem Hastalik Cerrahisi. 2012;23:166–167.
  5. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br. 2001;83(5):702–705. https://doi.org/10.1302/0301-620X.83B5.0830702
  6. Bierbaum BE, Calaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999;81:2–10. https://doi.org/10.2106/00004623-199901000-00002
  7. Callagan JJ, O’Rourke MR, Liu SS. Blood management: issues and options. J Arthroplasty. 2005;20:51–54. https://doi.org/10.1016/j.arth.2005.03.018
  8. Good L, Peterson E, Lisander B. Tranexamic acid decreases exernal blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90:596–599. https://doi.org/10.1093/bja/aeg111
  9. Sano M, Hakusui H, Kojima C, Akimoto T. Absorption and excretion of tranexamic acid following intravenous, intramuscular and oral administratios in healthy volunteers. Jpn J Clin Pharmacol Therapeutics. 1976;7:375–382. https://doi.org/10.3999/jscpt.7.375
  10. Zha GC, Zhu XR, Wang L, Li HW. Tranexamic acid reduces blood loss in primary total hip arthroplasty performed using the direct anterior approach: a one-center retrospective observational study. J Orthop Traumatol. 2022;7;23(1):12. https://doi.org/10.1186/s10195-022-00638-7
  11. Ralley FE, Berta D, Binns V, Howard J, Naudie DD. One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res. 2010;468:1905–1911. https://doi.org/10.1007/s11999-009-1217-8
  12. Benoni G, Bjorkman S, Fredin H. Application of pharmacokinetic data from healty volunteers for the prediction of plasma concentrations of tranexamic acid in surgical patients. Clin Drug Invest. 1995;10:280–287. https://doi.org/10.2165/00044011-199510050-00005
  13. Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion. 2008;48:519–525. https://doi.org/10.1111/j.1537-2995.2007.01564.x
  14. Camarasa MA, Olle G, Serra-Prat M, Martin A, Sanchez M, Ricos P, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth. 2006;96:576–582. https://doi.org/10.1093/bja/ael057
  15. Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthroplasty:a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012;470:2605–2612. https://doi.org/10.1007/s11999-012-2310-y
  16. Smith KM, Naudie DR, Ralley FE, Berta DM, Howard JL. One dose of tranexamic acid is safe and effective in revision knee arthroplasty. J Arthroplasty. 2013;28:112–115. https://doi.org/10.1016/j.arth.2013.05.036
  17. HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALTIT): an international randomised, double-blind, placebocontrolled trial. Lancet. 2020;20;395(10241):1927–1936. https://doi.org/10.1016/S0140-6736(20)30848-5
  18. Ellis M, Fredman B, Zohar E, Ifrach N, Jedeikin R. The effect of tourniquet application, tranexamic acid and desmopressin on the procoagulant and fibrinolytic systems during total knee replacement. J Clin Anesth. 2001;13:509–513. https://doi.org/10.1016/S0952-8180(01)00319-1
  19. Balachandar G, Abuzakuk T. Is there an optimal timing of administration of single-dose intravenous tranexamic acid in bilateral total knee arthroplasty? A comparison between preoperative and intraoperative dose. J Orthop Surg (Hong Kong). 2019;27(3):2309499019880915. https://doi.org/10.1177/2309499019880915
  20. Han X, Gong G, Han N, Liu M. Efficacy and safety of oral compared with intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a metaanalysis. BMC Musculoskelet Disord. 2018;3;19(1):430. https://doi.org/10.1186/s12891-018-2358-2.
  21. Luis C, Pardo A, Moreno CE, Teixell C, Santiveri X, Bisbe E. Clinical trial to determine whether the timing of tranexamic acid administration influences perioperative bleeding in total knee arthroplasty. Rev Esp Anestesiol Reanim (Engl Ed). 2022;69(9):517–525. https://doi.org/10.1016/j.redare.2021.05.021
  22. Engel JM, Hohaus T, Ruwoldt R, Menges T, Jürgensen I, Hempelmann G. Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or aprotinin. Anesth Analg. 2001;92(3):775–780. https://doi.org/10.1097/00000539-200103000-00041