Efficacy of Tranexamic Acid in Reducing Blood Loss and Transfusion Requirements in Primary Total Knee Arthroplasty: A Prospective Comparative Study.

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60 patients with Kellgren-Lawrence Grade 3 or 4 knee osteoarthritis undergoing primary unilateral total knee arthroplasty (TKA) were randomized to receive 1 g of intravenous tranexamic acid (TXA) 10 minutes before tourniquet release or 10 mL of normal saline at the same time point. The outcomes of interest were perioperative blood loss and transfusion requirements. Additional outcomes included postoperative drain output, hemoglobin levels, proportional hemoglobin loss, and thromboembolic complications. Outcomes were assessed intraoperatively and through postoperative day 3, with drain output measured at 24 and 48 hours. Overall, the results revealed that TXA significantly reduced intraoperative blood loss, postoperative drain output, proportional hemoglobin loss, and transfusion requirements compared with normal saline, with no thromboembolic complications observed in either group. These findings suggest that intravenous TXA is an effective blood conservation strategy for patients undergoing primary TKA.