This is an interesting prospective study on the effects of low-dose tranexamic acid (TA) in reducing blood loss and transfusion requirements in minimally invasive total knee arthroplasy (MIS-TKA). TA was administered intraarticularly or intravenously. A third group of patients received a placebo. Each group consisted of 50 patients and the results clearly show a significant advantage in both groups that received TA compared to placebo. Complications (deep vein thrombosis and atrial fibrilation) were few, not differing significantly between groups. There was no symptomatic pulmonary embolism.

The paper presents methodological limitations, as correctly pointed out by the authors: mainly the lack of control of asymptomatic patients for identification of subclinical deep vein thrombosis or pulmonary embolism, representing possible complications of TA administration. Table 3 is incorrect, confusing the reader as for the occurrence of symptomatic complications.

However, the results are clear and well documented, favoring low dose TA administration. In fact, it was shown that the intraarticular route gives better results than intravenously with less complications. I believe this is a paper worth reading as it may have a significant clinical impact in MIS-TKA. It should be pointed out, however, that further studies are required to investigate the possibility of complications as well as the effect of TA in conventional TKA and not only MIS-TKA.

– Constantine Vagianos