Abstract
Tranexamic acid is a synthetic anti-fibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin which acts to break down established clots and clotting factors. It was discovered by the husband and wife team of Shosuke and Utako Okamoto in 1962 in their search for an effective treatment of post-partum haemmorhage. 1 It became more well known when it was accepted on the WHO list of essential medicines and its use is now generally widespread as a useful means of reducing bleeding during surgery.
The journal has recently published a meta-analysis of eight relevant papers comparing blood loss following intra-articular versus intravenous administration of tranexamic acid in patients undergoing single knee replacement. 2 In general this review reflects most other findings that topical administration tends to be less effective than intravenous administration although there is no statistical difference overall. The benefit of reduction of thromboembolic events when administering the drug locally does not seem to materialize. 3
In this journal another point of view is presented by Sivasubramanian et al. who performed a single institution retrospective review which compares peri-articular administration against intra-articular administration. The relevance of the finding will need to be confirmed with more rigorous research. In the meantime, almost all methods of administration appear to be equally effective with the same incidence of thromboembolic complications.
