Tranexamic Acid and Drain Use in Knee Arthroplasty

NCT ID: NCT07174895

Last Updated: 2025-09-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

192 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-08-06

Study Completion Date

2025-04-01

Brief Summary

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This prospective randomized clinical study is designed to evaluate the effects of intra-articular tranexamic acid (TNA), with or without suction drainage, on perioperative blood management in patients undergoing total knee arthroplasty (TKA) for degenerative arthritis. A total of 192 patients will be randomly assigned to three groups: Group 1 will receive TNA with suction drainage, Group 2 will receive TNA only, and Group 3 will receive suction drainage only.

The primary outcomes will be total blood loss and transfusion requirements. Secondary outcomes will include hidden blood loss, drainage volume, postoperative limb swelling, wound-related complications, and knee range of motion. The study will help clarify whether suction drainage is necessary when intra-articular TNA is used during TKA.

Detailed Description

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Total knee arthroplasty (TKA) is commonly associated with significant perioperative blood loss, which may increase transfusion requirements and associated risks such as immunologic reactions, infection, and delayed recovery. Tranexamic acid (TNA) is an antifibrinolytic agent that inhibits fibrinolysis by blocking the activation of plasminogen. Suction drainage is frequently used to prevent hematoma formation, but its benefit in reducing transfusion needs remains controversial.

This single-center, prospective randomized study will enroll 192 patients undergoing unilateral TKA for degenerative arthritis. Participants will be assigned to three groups: (1) TNA with suction drainage, (2) TNA only, and (3) suction drainage only. TNA will be administered intra-articularly at a dose of 3 g in 100 mL normal saline after wound closure. When applied, suction drains will be activated two hours postoperatively.

The primary outcomes will be total blood loss and transfusion requirement. The secondary outcomes will include hidden blood loss, drainage volume, postoperative limb swelling, wound-related complications, and knee range of motion at two months. Statistical analysis will be conducted using ANOVA, repeated-measures t-tests, and chi-square tests, with significance set at p ≤ 0.05.

Conditions

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Osteoarthritis, Knee

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

\> This is a prospective randomized clinical trial including 192 patients undergoing total knee arthroplasty. Participants were randomly assigned to one of three groups to assess the effects of intra-articular tranexamic acid and/or suction drainage on total and hidden blood loss, transfusion requirements, postoperative limb swelling, wound-related complications, and knee range of motion.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Not applicable. The study was conducted as an open-label trial with no blinded parties.

Study Groups

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Tranexamic Acid with Suction Drainage

Patients undergoing total knee arthroplasty received intra-articular injection of 3 g tranexamic acid diluted in 100 mL normal saline after wound closure. A closed suction drain was inserted intra-articularly and subcutaneously, activated two hours postoperatively.

Group Type EXPERIMENTAL

Intra-articular Tranexamic Acid + Suction Drainage

Intervention Type DRUG

Patients received intra-articular injection of 3 g tranexamic acid in 100 mL normal saline after wound closure, along with a closed suction drain inserted intra-articularly and subcutaneously, activated two hours postoperatively.

Tranexamic Acid without Drainage

Patients undergoing total knee arthroplasty received intra-articular injection of 3 g tranexamic acid diluted in 100 mL normal saline after wound closure. No suction drain was used in this group.

Group Type EXPERIMENTAL

Intra-articular Tranexamic Acid

Intervention Type DRUG

Patients received intra-articular injection of 3 g tranexamic acid in 100 mL normal saline after wound closure. No suction drain was used.

Suction Drainage without Tranexamic Acid

Patients undergoing total knee arthroplasty had a closed suction drain inserted intra-articularly and subcutaneously, activated two hours postoperatively. No tranexamic acid was administered in this group.

Group Type ACTIVE_COMPARATOR

Suction Drainage Only

Intervention Type DEVICE

Patients had a closed suction drain inserted intra-articularly and subcutaneously, activated two hours postoperatively. No tranexamic acid was administered.

Interventions

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Intra-articular Tranexamic Acid + Suction Drainage

Patients received intra-articular injection of 3 g tranexamic acid in 100 mL normal saline after wound closure, along with a closed suction drain inserted intra-articularly and subcutaneously, activated two hours postoperatively.

Intervention Type DRUG

Intra-articular Tranexamic Acid

Patients received intra-articular injection of 3 g tranexamic acid in 100 mL normal saline after wound closure. No suction drain was used.

Intervention Type DRUG

Suction Drainage Only

Patients had a closed suction drain inserted intra-articularly and subcutaneously, activated two hours postoperatively. No tranexamic acid was administered.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patients with degenerative knee arthritis
* Scheduled for unilateral total knee arthroplasty

Exclusion Criteria

* Rheumatoid arthritis
* Cardiovascular diseases (e.g., angina, myocardial infarction, arrhythmia, cerebrovascular events)
* Coagulation disorders or thromboembolic disorders
* Severe infections
* Other serious health issues
Minimum Eligible Age

50 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Idlib University

OTHER

Sponsor Role lead

Responsible Party

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Mhmoud Adnan Al salamah

Principal Investigator, Department of Orthopedic Surgery, Idlib University

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mhmoud Adnan Al-Salamah

Role: PRINCIPAL_INVESTIGATOR

Idlib University

Locations

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Faculity of Medicine

Idlib, , Syria

Site Status

Countries

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Syria

References

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Hishimura R, Onodera T, Ohkoshi Y, Okada K, Matsuoka M, Matsubara S, Iwasaki K, Kondo E, Iwasaki N. The effect of local injection of tranexamic acid into peri-articular tissue versus drain clamping in total knee arthroplasty: a randomized controlled trial. BMC Musculoskelet Disord. 2022 Feb 2;23(1):111. doi: 10.1186/s12891-022-05058-6.

Reference Type BACKGROUND
PMID: 35109837 (View on PubMed)

Kim MK, Ko SH, Nam YC, Jeon YS, Kwon DG, Ryu DJ. Optimal Release Timing of Drain Clamping to Reduce Postoperative Bleeding after Total Knee Arthroplasty with Intraarticular Injection of Tranexamic Acid. Medicina (Kaunas). 2022 Sep 5;58(9):1226. doi: 10.3390/medicina58091226.

Reference Type BACKGROUND
PMID: 36143903 (View on PubMed)

Liu CH, Chang CH, Chang YH, Shih HN, Hu CC. Topical Fibrin Sealant (Tisseel@) Does Not Provide a Synergic Blood-Conservation Effect with Tranexamic Acid in Total Knee Arthroplasty-A Prospective Randomized Controlled Trial. Medicina (Kaunas). 2023 Nov 26;59(12):2078. doi: 10.3390/medicina59122078.

Reference Type BACKGROUND
PMID: 38138181 (View on PubMed)

Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L. The effects of hypotensive anesthesia and regional anesthesia on intraoperative blood loss in total knee arthroplasty. World J Emerg Surg. 2024;19(1):33. doi:10.1186/s13017-024-00554-7

Reference Type BACKGROUND

Chaiyakit P, Kabkaew P, Hongku N, Wattanapreechanon P. Comparison of total blood loss between limited tourniquet use and conventional tourniquet use in total knee arthroplasty: a randomized controlled trial. BMC Musculoskelet Disord. 2024 Nov 15;25(1):918. doi: 10.1186/s12891-024-08058-w.

Reference Type BACKGROUND
PMID: 39548417 (View on PubMed)

Zhou C, Gao X, Han H, Wang L, Jiang H. The efficacy and safety of tranexamic acid in primary total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1):37. doi:10.1177/15563316231208716.

Reference Type BACKGROUND

Liu Y, Ai J, Teng X, Huang Z, Wu H, Zhang Z, Wang W, Liu C, Zhang H. Risk factor analysis and establishment of a nomogram model to predict blood loss during total knee arthroplasty. BMC Musculoskelet Disord. 2024 Jun 10;25(1):459. doi: 10.1186/s12891-024-07570-3.

Reference Type BACKGROUND
PMID: 38858713 (View on PubMed)

Gonzalez-Pola R, Tafoya-Olivos RO, Culebras-Almeida LA, Zermeño-Garcia G, Herrera-Lozano A. Minimizing bleeding and transfusion in single-stage bilateral hip and knee arthroplasty: a systematic review of current interventions. Rev Esp Cir Ortop Traumatol (Engl Ed). 2025;69(2):e58. doi:10.1016/j.recot.2025.02.002.

Reference Type BACKGROUND

Ju Y, Liu H, Jiang W, Huang Q, Zhou Z, Pei F. Perioperative blood loss of sequential administration of hemocoagulase Agkistrodon and Tranexamic acid for primary total knee arthroplasty: a randomized controlled trial. J Orthop Surg Res. 2025 May 13;20(1):457. doi: 10.1186/s13018-025-05867-0.

Reference Type BACKGROUND
PMID: 40355919 (View on PubMed)

Liangliang L, Wei H, Tao Z, Pin P, Lianying H. Efficacy and safety of tranexamic acid in reducing hidden blood loss during unilateral total knee arthroplasty: a retrospective study. Front Med (Lausanne). 2025 Jun 3;12:1552893. doi: 10.3389/fmed.2025.1552893. eCollection 2025.

Reference Type BACKGROUND
PMID: 40529153 (View on PubMed)

Other Identifiers

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NW-Syria-TKA-Study-01

Identifier Type: OTHER

Identifier Source: secondary_id

T.A in Knee Arthroplasty

Identifier Type: -

Identifier Source: org_study_id

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