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Ex Vivo Human Chondrocyte Toxicity After Exposure to Tranexamic AcidExposure Acid

Abstract

Background: Tranexamic acid (TXA) reduces blood loss by inhibiting plasminogen and preventing subsequent fibrinolysis (stabilizing fibrin clots). Topical TXA has been suggested for use in unicompartmental joint arthroplasty and other procedures with residual viable cartilage. However, the effects on human cartilage have not been thoroughly investigated. The purpose of this study is to determine the viability of human chondrocytes in the setting of various concentrations of topical TXA. Methods: 24 human osteochondral (OC) plugs were harvested from the knee joint of a human decedent within 36 hours of death. OC plugs underwent two rinses with Dulbecco’s Phosphate-Buffered Saline (DPBS) and were then exposed to three concentrations of topical TXA (20 mg/mL, 30 mg/mL, 40 mg/mL) and incubated at 37°C for 48 hours. Control OC plugs were exposed to normal saline (NS). Chondrocyte viability was evaluated with a live/dead viability/cytotoxicity assay at days 0, 2, 4, and 6 after incubation. Results: For days 0 and 2, viability after TXA exposure was 70.0% ± 15.0% for all concentrations. By day 4, viability dropped to averages below 30.0% for all concentrations. Gross structural breakdown of extracellular matrix surrounding the chondrocytes was observed by day 6. Conclusion: Commonly used concentrations of topical TXA were shown to be chondrotoxic, and topical application in the presence of native cartilage could result in devastating effects on chondrocyte viability leading to patient morbidity. Use of TXA on native cartilage should be used with caution.

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