Comparison of the Utilization of Tranexamic Acid and Tourniquet Use in Total Knee Arthroplasty: A Retrospective Case Series

Abstract

Introduction: Total knee arthroplasty (TKA) carries a high risk for significant blood loss due to bone cuts and extensive soft tissue involvement in the knee region. The use of tranexamic acid (TXA) or a tourniquet are two methods commonly employed to prevent significant blood loss and avoid the need for blood transfusion. TXA has been shown to reduce both intraoperative and postoperative bleeding as well as the probability that a patient will require a blood transfusion. The purpose of this study is to compare the efficacy of TXA and tourniquet use, both alone and in combination, in reducing blood loss during TKA. Methods: Data for this retrospective cohort study were obtained by searching records of patients who underwent TKA at a tertiary care center from January 2019 to October 2020. Data from 526 subjects were available. A chart review was conducted to determine if the patient received TXA only, tourniquet only, or both TXA and tourniquet during the TKA procedure. Primary outcomes for this study including procedure length in minutes, estimated blood loss in cubic centimeters, and total infusion pressor (phenylephrine) administered intraoperatively in milligrams were recorded for the study. Data were summarized using means and standard errors. Statistical methods used for analysis include one-way ANOVA, probability plots, the Shapiro-Wilk test for normality, the Kruskal-Wallis test, and Tukey’s test. Results: Data were available for 526 subjects. 122 subjects received tourniquet only (Tourniquet group), 104 received intravenous (IV) TXA only, 264 received both tourniquet and IV TXA (Tourniquet + TXA), and 36 received neither tourniquet nor TXA (None). The groups did not significantly differ in procedure length (p = 0.140) or infusion pressor total (p > 0.20). The groups did significantly differ in estimated blood loss (p < 0.001). Subjects who did not receive either TXA or tourniquet had significantly more blood loss than the Tourniquet and Tourniquet + TXA groups. Similarly, the TXA group had significantly more blood loss than both the Tourniquet and Tourniquet + TXA groups. Conclusion: This study supports the conclusion that the use of a tourniquet is superior to the use of TXA in reducing intraoperative blood loss during TKA. All groups that underwent TKA using a tourniquet, either alone or in combination with TXA, exhibited significantly lower levels of blood loss compared to the control (no intervention) group.

Blood-conserving and therapeutic efficacy of intravenous tranexamic acid at different time points in primary total knee arthroplasty with tourniquet application: a randomized controlled trial

“…Tranexamic acid, one of the commonly used anti brinolytic drugs in clinical practice, is a lysine synthetic derivative that reversibly blocks the lysine binding site on brinolytic enzymes and brinogen, resulting in the inability of brinogen to bind to brin molecules, thus achieving anti brinolytic effects [21] and antagonizing the brinolytic hyperactivity stimulated by tourniquet application in terms of mechanism of action to achieve a balance between bleeding and hemostasis [22]. The main uses are intravenous and topical joint cavity administration, and the combination of the two modalities is more effective than individual application.…”

Sea Cucumber‐Inspired Aerogel for Ultrafast Hemostasis of Open Fracture

“…[ 2 ] The development of a high‐performance hemostatic material for rapid hemostasis in such scenarios as high energy bone trauma is therefore of great importance. Currently, a series of commercial hemostatic materials including tourniquets, [ 3 ] medical gauze, [ 4 ] Gelatin sponges, [ 5 ] hemostatic hydrogel, [ 6 ] and nanoclays [ 7 ] have been developed and brought into play. These materials have proven to be very effective in hemostasis over many years of practice, but they still have corresponding limitations in dealing with deep wounds and large areas of bleeding.…”