Low-Dose Exposure to Tranexamic Acid Has No Significant Toxic Effect on Human Cartilage Publisher



A Sherafatvaziri ARASH ; Mh Nabian Mohammad HOSSEIN ; F Vosoughi FARDIS ; E Madreseh ELHAM ; A Mirzamohamadi ALIREZA ; R Shayanmoghadam RAMIN
Source: Knee Published:2025

Abstract

Background: Recent studies have raised concerns about the potential cytotoxic effects of tranexamic acid (TXA) on cartilage. This study aimed to evaluate the safety of low-dose TXA exposure on human cartilage. Method: In this ex-vivo study, 30 patients with a varus osteoarthritic knee undergoing total knee arthroplasty (TKA) were enrolled. During the surgery, a set of six osteochondral plugs was harvested from the apparently intact lateral condyle of each patient's femur, resulting in a total of 180 plugs. Subsequently, all three plugs of each set were randomly exposed to one of the TXA treatment groups: 1 mg/ml (TI group), 5 mg/ml (TV group), or 10 mg/ml (TX group) of TXA. The remaining three plugs of each set were assigned to the control group and exposed to 0.9 % saline as a match for comparison. The effects of TXA dose and exposure time on cell viability were assessed using acridine orange/propidium iodide staining at baseline, 3, and 6 h post-exposure. Results: Cell viability decreased over time in the TI, TV, TX, and control groups compared with their baselines (P = 0.006, P < 0.001, P = 0.001, P < 0.001, respectively). However, the differences in the trend of decline were not statistically significant between groups (P = 0.3), and direct comparisons among TXA concentrations and saline control at baseline, 3, and 6 h after exposure showed no statistically significant difference in cell death (P = 0.538, P = 0.256, P = 0.287, respectively). Conclusions: Exposure to low-dose TXA (≤10 mg/ml) for up to 6 h did not cause significant toxic effects on human cartilage. © 2025 Elsevier B.V., All rights reserved.