Yağmur IŞIN, Mehmet ERDURAN, Yavuz Selim KARA, Mustafa ÇELTİK
Cyprus Journal of Medical Sciences - 2026;11(3):197-201
BACKGROUND/AIMS: This paper evaluates how tourniquet use and tranexamic acid (TXA) combinations affect blood management in primary total knee arthroplasty (TKA). MATERIALS AND METHODS: Following ethical approval, a retrospective review was conducted of 96 patients who underwent primary TKA between 2014 and 2017. Patients were divided into four groups: Group 1, no tourniquet with intravenous (IV) TXA 15 mg/kg plus intra-articular (IA) TXA 2 g; Group 2, tourniquet only (control); Group 3, tourniquet with IV TXA; and Group 4, no tourniquet with IA TXA. Demographic data, changes in perioperative hemoglobin (Hb) and hematocrit (Hct), intraoperative blood loss, postoperative drainage volume, and transfusion rates were analyzed using ANOVA and Kruskal-Wallis tests. RESULTS: The reduction in Hb and Hct was significantly smaller in patients receiving TXA (p<0.05). Group 1 demonstrated the least perioperative Hb decrease (1.3+/-0.8 g/dL) and the lowest transfusion rate (4%), whereas the control group showed the greatest Hb decline (3.5+/-1.0 g/dL) and highest transfusion requirement (34%) (p<0.05). The mean drainage volume was 180+/-50 mL in Group 1, lower than in other groups (p<0.05). No thromboembolic or wound-related complications were observed in any TXA-treated group. CONCLUSION: Dual-route TXA administered without a tourniquet reduces blood loss and the need for transfusions in TKA without increasing the risk of complications. Tourniquet use alone did not confer any additional hemostatic benefit and may be safely omitted when an optimized TXA protocol is implemented. These findings highlight that pharmacologic antifibrinolytic therapy offers a more effective and safer blood management strategy than mechanical occlusion methods in modern knee arthroplasty practice.
