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World J Orthop. Jun 18, 2022; 13(6): 555-563
Published online Jun 18, 2022. doi: 10.5312/wjo.v13.i6.555
Topical use of tranexamic acid: Are there concerns for cytotoxicity?
Ioannis Gkiatas, Aristeidis-Panagiotis Kontokostopoulos, Spyridon E Tsirigkakis, Ioannis Kostas-Agnantis, Ioannis Gelalis, Anastasios Korompilias, Emilios Pakos
Ioannis Gkiatas, Aristeidis-Panagiotis Kontokostopoulos, Spyridon E Tsirigkakis, Ioannis Kostas-Agnantis, Ioannis Gelalis, Anastasios Korompilias, Emilios Pakos, Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45500, Epirus, Greece
Author contributions: Gkiatas I and Kontokostopoulos AP wrote the manuscript; Gkiatas I, Kontokostopoulos AP, and Pakos E performed the data research; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aristeidis-Panagiotis Kontokostopoulos, MD, Academic Research, Department of Orthopaedic Surgery, University of Ioannina, Stavrou Niarchou, Ioannina 45500, Epirus, Greece. ariskontok9@gmail.com
Received: February 10, 2022
Peer-review started: February 10, 2022
First decision: April 13, 2022
Revised: April 23, 2022
Accepted: June 14, 2022
Article in press: June 14, 2022
Published online: June 18, 2022
Processing time: 126 Days and 20.1 Hours
Abstract

Tranexamic acid (TXA) has revolutionized modern blood management in orthopaedic surgery, especially in total joint arthroplasty, by significantly reducing blood loss and transfusion rates. It is an antifibrinolytic agent and a synthetic derivative of the amino acid lysine, which can inhibit the activation of plasminogen and the fibrin breakdown process. The administration of TXA can be intravenous (IV), topical, and oral. In patients where the IV administration is contraindicated, topical use is preferred. Topical administration of the drug theoretically increases concentration at the operative site with reduced systemic exposure, reduces cost, and gives the surgeon the control of the administration. According to recent studies, topical administration of TXA is not inferior compared to IV administration, in terms of safety and efficacy. However, there are concerns regarding the possible toxicity in the cartilage tissue with the topical use of TXA mainly in hemiarthroplasty operations of the hip, unilateral knee arthroplasties, total knee arthroplasties where the patella is not resurfaced, and other intraarticular procedures, like anterior cruciate ligament reconstruction. The purpose of the present review is to present all the recent updates on the use of TXA focusing on the toxicity on chondrocytes and the articular cartilage that may or may not be provoked by the topical use of TXA.

Keywords: Tranexamic acid; Topical use; Cytotoxicity; Orthopaedic surgery

Core Tip: Tranexamic acid (TXA) is an antifibrinolytic agent and is associated with decreased blood loss in surgical procedures. It is widely used in major orthopaedic procedures in order to decrease blood transfusion needs. TXA can be administered intravenously; however, topical administration of the drug increases concentration at the operative site. There are concerns that this increased concentration may cause toxicity in the cartilage tissue. In this review, we present the recent literature regarding the cytotoxic effects of the topical administration of TXA.