For many people, hip or knee surgery represents a major step toward greater mobility and quality of life. At the same time, these procedures carry a certain amount of risk—primarily the risk of blood loss. It used to be almost standard practice for patients to require a blood transfusion after a hip replacement (THA) or knee replacement (THA). Today, thanks to modern medications and surgical techniques, this is almost never the case. One of the key factors in this is tranexamic acid .

In this comprehensive guide you will learn:

• What tranexamic acid is and how it works.
• How it is used in endoprosthetics (hip and knee prostheses).
• Why it is considered a “game changer.”
• What side effects and contraindications there are.
• What the term off-label use means and why it is important for patients.
• Why ENDOPROTHETICUM Rhein-Main relies on tranexamic acid to ensure maximum safety.

History and development of tranexamic acid

Tranexamic acid was developed in Japan in the 1960s. Researchers were looking for a drug that could inhibit the breakdown of blood clots. It was soon discovered that the active ingredient could help with surgeries, injuries, and even heavy menstrual bleeding. Tranexamic acid has been on the market for many decades Cyclokapron®

However, its use in orthopedics and trauma surgery only truly gained traction in the last two decades. Only when studies clearly demonstrated that tranexamic acid can significantly reduce bleeding did it become an integral part of endoprosthetics, particularly in the implantation of hip and knee replacements.

How does blood clotting work?

To understand why tranexamic acid is so effective, it's worth looking at the body's own blood clotting process . When a blood vessel is injured, the body attempts to stop the bleeding immediately. Three processes work together to do this:

1. Vasoconstriction : The blood vessels contract.
2. Blood platelets (thrombocytes) attach themselves to the injured area.
3. Fibrin – a kind of “glue” – ensures that a stable blood clot forms.

To maintain blood flow, the body also has mechanisms to dissolve clots. This process is fibrinolysis . This is precisely where tranexamic acid comes in: It inhibits the enzyme plasmin , which is responsible for breaking down clots. This keeps the clots stable, and the bleeding stops more quickly.

How is tranexamic acid administered?

Depending on the clinic and patient, there are different methods:

• Intravenous (IV) : The substance is administered directly into the bloodstream via a vein. This usually occurs shortly before or during surgery.
• Oral (tablets) : Some clinics administer tablets to patients before or after surgery. Studies show that this form can be just as effective.
• Local/intra-articular : With this method, tranexamic acid is injected directly into the surgical site—e.g., the knee joint. This targets the bleeding site.

Many clinics combine intravenous and local administration to enhance the effect. This combination is considered particularly safe and effective.

Tranexamic acid as a game changer in endoprosthetics (hip arthroplasty, knee arthroplasty)

Just 15 years ago, it was common for many patients to require a blood transfusion after hip or knee surgery. While these blood transfusions saved lives, they also carried risks: the risk of infection, immune reactions, and sometimes even organ damage.

Since the introduction of tranexamic acid, these risks have been drastically reduced:

• Transfusion rates have fallen below 5% .
• Patients can be mobilized more quickly.
• Complications such as infections or circulatory problems occur less frequently.

In combination with minimally invasive surgical techniques and modern fast-track concepts (rapid rehabilitation), tranexamic acid is a central component for safe endoprosthetics.

Tranexamic acid and fast-track concepts in endoprosthetics

The modern fast-track concept —sometimes called "Enhanced Recovery After Surgery" (ERAS)—aims to get patients mobile and independent again as quickly as possible after total hip or total knee replacement surgery. Every hour you can get up and walk earlier reduces the risk of complications such as thrombosis, pneumonia, or muscle atrophy.

Tranexamic acid plays a key role here :

• Less blood loss means less weakness and circulatory problems.
• Patients require less blood transfusions , which could otherwise place additional strain on the circulatory system.
• The more stable circulation allows you to get up earlier and do walking exercises .
• Rapid mobilization, in turn, reduces the risk of infection and accelerates healing.

In short, tranexamic acid is a key component in enabling fast-track concepts in arthroplasty to function at all. It makes modern "fast recovery" safe and effective.

Why is the use of tranexamic acid sometimes considered off-label?

Although tranexamic acid has been approved for decades, this approval does not automatically cover all conceivable applications. Intra-articular administration (i.e., direct injection into the joint) is not officially included in the approval in Germany, for example. If it is used, such as in the context of a total hip or knee replacement, it is referred to as " off-label use .

This means that doctors are permitted to use the method, but they must inform you in advance. This way, you as a patient are fully aware that while it is a safe and proven method, it is not explicitly approved by the drug regulatory authority.

Contraindications – when should tranexamic acid not be given?

Tranexamic acid is a very safe medication. However, there are situations in which it is not recommended:

• Severe kidney disease : The active ingredient can accumulate in the body.
• History of thrombosis or pulmonary embolism
• Epileptic seizures : Tranexamic acid may, under certain circumstances, increase the risk of seizures.

Before surgery, your doctor will determine whether the procedure is appropriate for you. This assessment is part of the safety standard.

Safety of tranexamic acid – what do studies say?

Numerous international studies have shown that tranexamic acid does not increase . This has long been a concern for many physicians. Today, it is considered certain: the benefits clearly outweigh the risks, and safety is high. Therefore, tranexamic acid is now standard worldwide for joint replacement surgeries such as hip or knee replacements.

Patient Questions (FAQ)

1. Should I be concerned about side effects?
No, in the vast majority of cases, tranexamic acid is well tolerated. Your doctor will check for any risk factors before surgery.

2. Will it reduce my pain?
Tranexamic acid doesn't relieve pain. But because of the reduced blood loss, you'll recover faster and be able to start rehabilitation sooner.

3. Is the medication expensive?
No, tranexamic acid is a very inexpensive medication—especially compared to the costs and risks of a blood transfusion.

4. Will I automatically receive the treatment?
In most specialized clinics, tranexamic acid is now standard therapy. Speak to your medical team directly about this. You will be explained how to use it prior to surgery.

Tranexamic acid and modern endoprosthetics in Mainz

At ENDOPROTHETICUM Rhein-Main, under the direction of Prof. Dr. Karl Philipp Kutzner, the highest standards of safety are taken into account when performing hip and knee replacements. Tranexamic acid is a natural part of the treatment concept. Combined with minimally invasive techniques and gentle rehabilitation programs, this creates a holistic approach for successful surgery.

Summary

• Tranexamic acid (Cyclokapron®) is a drug that effectively reduces bleeding during surgery.
• It is used in hip and knee prostheses – intravenously, orally or locally.
• Thanks to it, blood transfusions in primary hip or knee replacement surgeries are now almost unnecessary.
• Some uses are considered off-label, but only require brief explanation.
• Studies confirm: The risk of thrombosis is not increased.
• Patients benefit from greater safety and faster recovery.

Conclusion: Tranexamic acid is a game changer in modern endoprosthetics

Would you like a modern hip or knee prosthesis with maximum safety? Then ENDOPROTHETICUM Rhein-Main in Mainz is the right place for you. Under the direction of Prof. Dr. Karl Philipp Kutzner, you will receive personalized advice and treatment based on the latest scientific standards – naturally including the use of tranexamic acid .

👉 Make your appointment now: www.endoprotheticum.de