Abstract: BACKGROUND: High tibial osteotomy results in massive blood loss during the perioperative period. Tranexamic acid can effectively reduce perioperative blood loss. However, the method of tranexamic acid application has not been unified.  
OBJECTIVE: To investigate the effect and safety of different methods of tranexamic acid on perioperative blood loss in the high tibial osteotomy.
METHODS: A total of 160 patients who underwent primary unilateral high tibial osteotomy in the Binzhou Medical University Hospital from January 2019 to December 2021, including 69 males and 91 females, were randomly divided into four groups (n=40 per group). Among them, 40 patients were given an intravenous infusion of saline containing 2 g tranexamic acid 10 minutes before tourniquet release (venous group); 40 patients were given an intravenous infusion of 1 g tranexamic acid and 1 g tranexamic acid was injected through a drainage tube after the closure of the incision (combined group); 40 patients were given 2 g tranexamic acid infusion into drainage tube after the closure of the incision (perfusion group); an additional 40 patients were given an intravenous infusion of the same amount of normal saline (blank group). The general information was compared among the four groups of patients. The hemoglobin, hematocrit, intraoperative blood loss, drainage volume, blood transfusion rate, incision complication, and the incidence of deep vein thrombosis were recorded on days 1, 3 and 5 after operation in the four groups. The total blood loss and hidden blood loss were calculated.  
RESULTS AND CONCLUSION: (1) There was no statistically significant difference in general information among the four groups. (2) No significant difference was found in intraoperative blood loss among the four groups. (3) The maximum decreased values of hemoglobin and hematocrit on days 1, 3 and 5 after operation, drainage volume, total blood loss and hidden blood loss were all ranked as the combined group < venous group < perfusion group < blank group. (4) The postoperative blood transfusion rate of the blank group was significantly higher than that of the other three groups, and there was no significant difference in the postoperative blood transfusion rate among the combined group, the venous group and the perfusion group. (5) There was no significant difference in the incidence of venous thrombosis and incision complications among the four groups. (6) It is indicated that the application of tranexamic acid in high tibial osteotomy can reduce perioperative bleeding and postoperative blood transfusion rate, and the effect of intravenous infusion combined with drainage tube perfusion is better, which does not increase the incidence of venous thrombosis and incision complications.

Key words: knee osteoarthritis, high tibial osteotomy, tranexamic acid, perfusion, blood loss, complication