Efficacy of tranexamic acid with/without drain in knee arthroplasty: a randomized prospective clinical study from Northwest Syria

Purpose: This study evaluated the outcomes of intra-articular tranexamic acid (TXA) and/or suction drainage in patients undergoing total knee arthroplasty (TKA). Materials and Methods: Following approval from the institutional review board, a prospective, randomized, and blinded clinical study was conducted in Northwest Syria, including 192 patients who underwent unilateral TKA between August 2023 and April 2025. Patients were randomly assigned to three groups: TXA with suction drainage, TXA only, or suction drainage only. Patients with coagulopathies, active infections, previous knee surgeries, or contraindications to TXA were excluded. All procedures followed a standardized surgical and postoperative protocol. Outcome measures included total and hidden blood loss (HBL), drainage volume, transfusion rate, limb swelling, and wound complications. Results: Total blood loss was lowest in Group 2 (710 mL) compared to Group 1 (891 mL) and Group 3 (1391 mL) ( P < 0.0001). No transfusions were required in Group 2, whereas 7.8% of Group 1 and 36% of Group 3 received transfusions ( P < 0.0001). No wound complications occurred in Group 2. HBL and early swelling were higher in Group 2 but resolved within 6 weeks. Knee range of motion at 2 months showed no significant differences among groups ( p = 0.0789). Conclusion: Intra-articular TXA without suction drainage appears to be the safest and most effective method to reduce perioperative blood loss in TKA. Larger multicenter studies are recommended.