***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background Recently , a number of studies using intra-articular application of tranexamic acid ( IA-TXA ) , with different dosage and techniques , successfully reduced postoperative blood loss in total knee replacement ( TKR ) . However , best of our knowledge , the very low dose of IA-TXA with drain clamping technique in conventional TKR has not been yet studied . This study aim ed to evaluate the effectiveness and dose-response effect of two low-dose IA-TXA regimens in conventional TKR on blood loss and blood transfusion reduction . Methods Between 2010 and 2011 , a triple-blinded r and omized controlled study was conducted in 135 patients undergoing conventional TKR . The patients were allocated into three groups according to intra-articular solution received : Control group ( physiologic saline ) , TXA-250 group ( TXA 250 mg ) , and TXA-500 group ( TXA 500 mg ) . The solution was injected after wound closure followed by drain clamping for 2 hours . Blood loss and transfusion were recorded .  Duplex ultrasound  was performed . Functional outcome and complication were followed for one year . Results There were forty-five patients per groups . The mean total hemoglobin loss was 2.9 g/dL in control group compared with 2.2 g/dL in both TXA groups ( p > 0.001 ) . Ten patients ( 22 % , control ) , six patients ( 13 % , TXA-250 ) and none ( TXA-500 ) required transfusion ( p = 0.005 ) . Thromboembolic events were detected in 7 patients ( 4 controls , 1 TXA-250 , and 2 TXA-500 ) . Functional outcome was non-significant difference between groups . Conclusions Combined low-dose IA-TXA , as 500 mg , with 2-hour clamp drain is effective for reducing postoperative blood loss and transfusion in conventional TKR without significant difference in postoperative knee function or complication . Trial registration Clinical Trials.gov NCT01850394 The objective of this study was to determine whether topical tranexamic acid ( TXA ) carried similar hemostatic effect compared with intravenous TXA in total hip arthroplasty ( THA ) . Three hundred and three THA patients were enrolled and r and omized into 3 groups : no TXA group , topical and intravenous TXA group . The results showed that the topical and intravenous TXA group had reduced but similar blood transfusion rates ( 5.88 % v. s. 5.94 % , P = 0.816 ) . No significant difference was detected in total blood loss between the two TXA groups [ ( 963.4 ± 421.3 ) ml vs. ( 958.5 ± 422 ) ml P = 0.733 ] . We conclude that topical use of TXA was equally effective and safe compared with intravenous TXA in reducing blood loss and transfusion rate following THA without substantial complications Background Diffuse microvascular bleeding remains a common problem after cardiac procedures .Systemic use of antifibrinolytic reduces the postoperative blood loss . The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting ( CABG ) . Methods Thirty eight patients scheduled for primary isolated coronary artery bypass grafting were included in this double blind , prospect i ve , r and omized , placebo controlled study .Tranexamic acid ( TA ) group ( 19 patients ) received 1 gram of TA diluted in 100 ml normal saline . Placebo group ( 19 patients ) received 100 ml of normal saline only . The solution was purred in the pericardial and mediastinal cavities . Results Both groups were comparable in their baseline demographic and surgical characteristics . During the first 24 hours post-operatively , cumulative blood loss was significantly less in TA group ( median of 626 ml ) compared to Placebo group ( median of 1040 ml ) ( P = 0.04 ) . There was no significant difference in the post-op Packed RBCs transfusion between both groups ( median of one unit in each ) ( P = 0.82 ) . Significant less platelets transfusion required in TA group ( median zero unit ) than in placebo group ( median 2 units ) ( P = 0.03 ) . Apart from re-exploration for excessive surgical bleeding in one patient in TA group , no difference was found in morbidity or mortality between both groups . Conclusion Topical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient BACKGROUND Abundant literature regarding the use of intravenous tranexamic acid ( TXA ) in primary total knee replacement is available . R and omized controlled trials have confirmed the efficacy of topical TXA compared with placebo , but the comparison between topical and intravenous TXA is unclear . The present study was design ed to verify noninferior efficacy and safety of topical intra-articular TXA compared with intravenous TXA in primary total knee replacement with cemented implants . METHODS A Phase-III , single-center , double-blind , r and omized , controlled clinical trial was performed to compare topical intra-articular TXA ( 3 g of TXA in 100 mL of physiological saline solution ) with two intravenous doses of TXA ( 15 mg/kg in 100 mL of physiological saline solution , one dose before tourniquet release and another three hours after surgery ) in a multimodal protocol for blood loss prevention . The primary outcome was the blood transfusion rate , and the secondary outcomes included visible blood loss ( as measured in the drain ) at twenty-four hours postoperatively and invisible blood loss ( as estimated from the Nadler formula ) at forty-eight hours postoperatively . The sample size of seventy-eight patients was calculated to give a statistical power of 99 % for demonstrating noninferiority . Thirty-nine patients each were allocated to receive topical intra-articular TXA ( the experimental group ) and intravenous TXA ( the control group ) ; there were no significant differences in demographics or preoperative laboratory values between the groups . Noninferiority was estimated by comparing the confidence intervals with a delta of 10 % . Student t and Mann-Whitney tests were used to assess the significance of any differences . RESULTS The transfusion rate was zero in both groups ; thus , noninferiority was demonstrated for the primary efficacy end point , suggesting equivalence . Noninferiority was also demonstrated for the secondary efficacy end points . Drain blood loss at twenty-four hours was 315.6 mL ( 95 % confidence interval [ CI ] , 248.5 to 382.7 mL ) in the experimental group and 308.1 mL ( 95 % CI , 247.6 to 368.5 mL ) in the control group ( p = 0.948 , Mann-Whitney ) . Also , estimated blood loss at forty-eight hours was 1259.0 mL ( 95 % CI , 1115.6 to 1402.3 mL ) in the experimental group and 1317.9 mL ( 95 % CI , 1175.4 to 1460.4 mL ) in the control group ( p = 0.837 , Mann-Whitney ) . No significant safety differences were seen between groups . CONCLUSIONS Topical administration of TXA according to the described protocol demonstrated noninferiority compared with intravenous TXA , with no safety concerns . This r and omized controlled trial supports the topical intra-articular administration of TXA in primary total knee replacement with cemented implants . LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence The ideal method of providing tranexamic acid ( TXA ) for decreasing hemoglobin drop after TKA is still controversial . In this clinical trial , 200 patients were r and omly allocated to four groups . In group 1,500 mg TXA was administered intravenously . In group 2 , the joint irrigated with 3 g of TXA in 100 cc of saline . In group 3 , 1.5 g of TXA was injected through the drain . Group 4 did not take TXA . Albeit all methods had a statistical effect on hemoglobin drop , drainage and number of transfused units when compared to controls , but intravenous injection of TXA seems to be much more effective in terms of reducing hemoglobin drop and transfused units ; and what 's more TXA injection by drain is more effective regarding to reducing postoperative drainage PURPOSE Perioperative hemorrhage is an important concern during  orthognathic surgery .  The purpose of this study was to assess the effect of tranexamic acid ( TXA ) irrigation on perioperative hemorrhage during orthognathic surgery . MATERIAL S AND METHODS In this double-blind , r and omized controlled clinical trial , 56 participants who underwent orthognathic surgery  were divided into 2 groups . The patients in the first group received TXA irrigation with normal saline ( 1 mg/mL ) , and the patients in the second group had normal saline for irrigation during orthognathic surgery . Age , gender , operation duration , the amount of irrigation solution used , and preoperative hemoglobin , hematocrit , and weight were the variables that were studied . The use of TXA solution for irrigation was the predictive factor of the study . RESULTS Each group consisted of 28 patients . Group 1 consisted of 15 male patients ( 53.6 % ) and 13 female patients ( 46.4 % ) and group 2 consisted of 14 male patients ( 50 % ) and 14 female patients ( 50 % ) . There was no difference in the distributions of the variables between the 2 groups , except for the duration of the operation . The mean duration of the operation was 3.94 ± 0.61 hours in group 1 and 4.17 ± 0.98 hours in group 2 , and the difference in this respect between the 2 groups was statistically significant ( P < .05 ) . The mean intraoperative blood loss was 817.85 ± 261.83 mL in group 1 and 575.00 ± 286.90 mL in group 2 ( P < .05 ) . The mean volume of irrigation was 1,057.14 ± 407.04 mL in group 1 and 843.57 ± 275.48 mL in group 2 ( P > .05 ) . CONCLUSIONS TXA is effective in reducing intraoperative blood loss in patients for whom substantial blood loss is anticipated The purpose of this study is to investigate the effect of preoperative intravenous ( IV ) and intraoperative topical administration of tranexamic acid ( TXA ) in total knee arthroplasty ( TKA ) . A total of 120 patients were and r and omly allocated to either topical group , combined group , or control group . The mean total blood loss was lower in the combined and topical groups ( 705 mL and 579 mL , respectively ) in comparison with control group ( 949 mL , P < 0.001 ) . There was a significant difference in transfusion rate among groups ( P = 0.009 ) . The postoperative hemoglobin drop and total drain amount were significantly less in the combined group compared to other groups . In conclusion , combining preoperative IV injection and topical administration of TXA can effectively reduce blood loss and transfusion rate Background Intravenous tranexamic acid ( IV TXA ) is one of the most effective agents in use for reducing blood loss following total knee arthroplasty ( TKA ) but its safety regarding venous thromboembolic events ( VTEs ) remains in question . The direct , local application of TXA may reduce systemic toxicity whilst maintaining good or better bleeding control compared to IV TXA . The topical application of TXA via Hemovac drains has been reported previously with good results . However , there are no data on peri-articular TXA injections during TKA . Methods We conducted an open r and omized , pilot study of peri-articular vs. IV TXA in 60 patients undergoing TKA . 30 patients received either : ( i ) 750 mg peri-articular TXA into the medial , lateral capsules and the quadriceps tendon prior to capsular closure and tourniquet deflation ( group1 ) , or ( ii ) 750 mg of IV TXA just before tourniquet deflation . Blood loss in the hemovac drain and hemoglobin ( Hb ) concentrations were measured at 24 and 48 h ( h ) , and the number of blood transfusions and leg circumference measurements were recorded . Results At 48 h , the total blood loss in the hemovac drain was 445 mL in group 1 vs. 520 mL in group 2 ( p = 0.081 ) and the corresponding declines in Hb were 1.85 g/dL vs. 1.87 g/dL ( p = 0.84 ) . 16 patients received blood transfusions : 9 vs. 7 in groups 1 and 2 , respectively ( p = 0.928 ) . There were no differences in thigh and lower leg circumferences , pain scores , knee flexion at discharge date and lengths of hospital stay . There were no clinical ly detected venous thromboembolic events . Conclusion This pilot study has shown promising results for peri- 
    Output:
    
The topical application of TXA effectively reduces both transfusion risk and blood loss compared to placebo , without increasing thromboembolic risks .
There were no major differences between topical and intravenous tranexamic acid with respect to safety and efficacy , and both were superior to placebo with regards to blood loss and transfusion requirements .