Summary

Based on our findings Transient exposure to low dose of TXA (10 mg/ml or less) did not show any significant toxic effect on human cartilage.

Abstract

Aims: While recent studies have raised concerns about the potential cytotoxic effects of Tranexamic acid (TXA) on cartilage, particularly in animal and human models, the safety of low-dose TXA exposure remains poorly defined. This study aims to address this gap by evaluating the safety of low-dose TXA on human cartilage.

Methods

Between April and June 2022, 30 patients undergoing total knee arthroplasty (TKA) were enrolled in the study. Each patient was randomly assigned to one of three groups (TI, TV, and TX). During the surgery, osteochondral samples were harvested from the femoral condyles after the femoral cut. A set of six osteochondral plugs were extracted from a single condyle of each patient, ensuring that only one condyle per patient was used, resulting in a total of 180 plugs. Subsequently, three plugs from each set were exposed to TXA based on their group: 1 mg/ml for the TI group, 5 mg/ml for the TV group, and 10 mg/ml for the TX group. The remaining three plugs were assigned to the control group and exposed to 0.9% saline as a match for comparison. The proportion of live chondrocytes was evaluated at baseline, 3, and 6 hours after exposure. Finally, the relationships between cell viability, TXA dose, and duration of exposure were assessed.

Results

According to our findings, although cell viability decreased in all case groups following increasing the time of TXA exposure, there was no statistically significant difference between the reduction of cell viability and the time of TXA exposure (P= 0.300). Cell viability also decreased in the control group. Increasing the concentration of TXA did not cause a significant decrease in cell viability.

Conclusion

Based on our findings transient exposure to a low dose of TXA (10 mg/ml or less) did not show any significant toxic effect on human cartilage.