Tranexamic acid (TA) injections following knee aspiration in cases of hemarthrosis of adult patients with hemophilia produced better short-term range of motion (ROM) and pain scores than aspiration procedures without the use of TA, according to the results of a small, randomized trial published in Haemophilia.
The researchers, from Tehran University of Medical Sciences in Iran, said the findings suggest that TA could be a safe and effective option for these patients, at least for shorter term effects over the first week or two.
In the trial, 21 patients were randomized to receive TA after knee aspiration and 17 to knee aspiration without TA. Both groups were comprised of all male patients. Those in the TA group received a 75 mL intra-articular (IA) injection, which included a 15 mL concentration of TA, along with 5 mL of 2% lidocaine and 55 mL of 0.9% saline. Those in the non-TA group received a 70 mL injection of saline with 5 mL of lidocaine. Researchers reported no complications related to the injections.
There was no difference in average knee ROM at 24 hours, but by day 3 researchers saw a difference — 79.06 for the TA group compared with 70.00 for the non-TA group (p=0.027). This difference continued to be seen on days 7 and 14, but by day 21, no difference was seen between the groups.
Patients in the TA group had lower pain scores on the Visual Analog Scale at 24 hours, with a score just above 4 for the TA group and a score of about 5 for the non-TA group (p<0.01). This difference persisted through days 3 and 7, but no difference was seen after that, researchers reported.
“The findings from our [randomized controlled trial] showed that combining joint aspiration with IA injection of [TA] in the management of acute knee hemarthrosis in hemophilia patients led to significant short-term improvements in ROM and pain relief,” the researchers said. “Although return to work and patient satisfaction showed a tendency to improve, the improvements were not statistically significant.”
Margaret Ragni, MD, MPH, professor of medicine at the University of Pittsburgh and director of the Hemophilia Center of Western Pennsylvania who was not involved in the study, said that for those who take factor therapy on-demand when bleeds occur, treatment within an hour or two of a bleed usually controls it, so a joint aspiration is not needed.
“For those who live in third-world countries or cannot afford to treat or have poor access to care or treatment, a severe bleed could precipitate severe pain and the need to have the joint tapped,” Dr. Ragni said.
That said, there is little evidence on TA use in these cases, she noted.
“Although a joint aspiration can bring great pain relief, there are very little data on using TA in this setting. While TA is a well-tolerated anti-fibrinolytic agent, little data are available on its safety or efficacy [when administered intra-articularly],” she explained. Some reports have suggested that IA injection of TA might cause death of chondrocytes, or joint articular cells, due to high concentrations of TA.
“Further, there are little data that joint outcomes — ROM, pain — if measured at six weeks, are much different whether or not TA is used. Further TA can be given (by mouth) or IV and, thus, may have less potential for direct toxic effect to joint cells, but there are no data comparing TA by different routes,” Dr. Ragni said. “While interesting, the bottom line is that prevention is the best medicine, i.e., taking factor or nonfactor therapy to prevent bleeds altogether.”
Any conflicts of interest declared by the authors can be found in the original article.
Reference
Kalantar SH, Razzaghof M, Noshadi Y, et al. Efficacy and safety of aspiration and intra-articular injection of tranexamic acid in acute knee hemarthrosis of adult haemophilic patients: a randomized clinical trial study [published online ahead of print, 2025 Feb. 7]. Haemophilia. doi: 10.1111/hae.70000.
