Critical Appraisal of Intravenous and Intra-Articular Tranexamic Acid in Total Knee Arthroplasty

Running head: CRITICAL APPRAISAL
Critical appraisal
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1CRITICAL APPRAISAL
The article focused on exploring the effect of intravenous injection of fibrinolytic
inhibitor tranexamic acid (TXA) combined with intra-articular injection (IA) of TXA in patients
who had undergone total knee arthroplasty (TKA). From the review of the research aim, it can be
said that the paper has a clear and focussed research question. The research aim and significance
of the study was further confirmed by review of introduction and literature review on the topic.
The key research problem that the study aimed to address included the issue of blood loss and
anaemia in patients after TKA. As blood loss after TKA result in increased hospital stay and
increase in economic and clinical burden, the literature review revealed about recent evidence of
the efficacy of TXA in reducing blood loss in a mouse model. The research gap that favoured
research in this area included lack of research to investigated about the efficacy of TXA in
patients after TKA (1). Hence, the research aim and question is justified by appropriate
discussion regarding gaps in research and research problem (2).
To investigate about the research topic, the study used randomized controlled trial (RCT)
method as the research design. This can be said as the researcher conducted the study with two
groups of people. The first group received TXA injection before and after TKA. In addition, the
second group received TKA by IV and by IA. The strength of using RCT is that it comes under
the highest level of evidence under evidence hierarchy. The process undertaken during RCT such
as allocation concealment, random sampling and equal treatment of group apart from
intervention plays a role in reducing biases and risk of systematic errors (3). Hence, this research
design is reflective of high quality research. In addition, the selection of research design is
appropriate according to the research question. The research aimed to study the effect of an
intervention (TXA) on patient outcome (blood loss after TKA) and RCT is the best method to