Effect of Multiple Doses of Intravenous Tranexamic Acid on Perioperative Blood Loss in Total Knee Arthroplasty: A Randomized Controlled Study

Abstract

Objective To identify the efficacy and safety of multiple doses of intravenous tranexamic acid (IV‐TXA) following primary total knee arthroplasty (TKA) with a tourniquet. Methods This is a single‐blind randomized controlled study that recruited osteoarthritis patients who had undergone primary unilateral TKA from May 2019 to May 2020 at our medical center. A total of 300 patients were randomly divided into three groups to receive: one dose (1 g) of IV‐TXA before skin incision combined with one dose (1.5 g) of intra‐articular tranexamic acid（IA‐TXA) followed by a single dose of IV‐TXA (1 g) for 3 h (group A); two doses of IV‐TXA (1 g) for 3 and 6 h (group B); or three doses of IV‐TXA (1 g) for 3, 6, and 12 h (group C) postoperatively. TKA with a tourniquet was performed by the same surgical team. The primary outcomes were total blood cell loss (TBL), hidden blood loss (HBL), maximum hemoglobin (Hb) drop, and transfusion rate. Secondary outcomes were levels of C‐reactive protein (CRP) and D‐dimer, and the incidence of postoperative complications. One‐way analysis of variance, subgroup analysis, and multivariate correlation analysis were used to calculate the differences among the three groups. Results The study included 56 male and 244 female patients aged 60–80 years. The mean TBL, the mean HBL, and the maximum Hb drop in group C (471.2 ± 190.6 mL, 428.4 ± 190.3 mL, and 21.2 ± 3.8 g/L, respectively) were significantly lower than those in groups B (563.4 ± 224.6 mL, P = 0.030; 519.9 ± 226.4 mL, P = 0.033; and 23.2 ± 4.1 g/L, P = 0.001, respectively), and A (651.6 ± 254.1 mL, P < 0.001; 607.1 ± 254.3 mL, P < 0.001; and 25.1 ± 4.3 g/L, P < 0.001, respectively). No transfusions were required. The postoperative acute inflammatory reaction was less problematic for patients in Group C, and the incidence of thromboembolic events was similar among the groups (P > 0.05). In addition, there were positive correlations between the HBL and the tourniquet inflation time (r = 0.844, P < 0.001). Similarly, the level of CRP on POD1 (r = 0.393, P < 0.001) and POD3 (r = 0.149, P = 0.010), and the level of D‐dimer on POD1 (r = 0.382, P < 0.001) were positively correlated with the HBL. Conclusion Three doses of postoperative IV‐TXA decreased blood loss and diminished the postoperative inflammatory and fibrinolytic response more than a single dose or two doses in elderly patients following TKA without increasing the incidence of adverse events.

Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials

“…36 Kang et al found that three doses of TXA decreased blood loss and diminished inflammatory and fibrinolytic responses more than a single dose or two doses in elderly patients. 27 Similar results were reported by using a five-dose in hip and knee surgery. 34,35 Goyal et al showed that there was no significant beneficial effect of three doses of TXA in bilateral total knee arthroplasty compared to a single dose.…”

“…This results is not consistent with clinical trial studies in hip and knee arthroplasty and no related literature reported in shoulder arthroplasty. 27,34,35,36,62 There is a consensus among surgeons that less bleeding is better for patients, but it is unclear whether differences in bleeding for shoulder arthroplasty are clinically significant.…”

The effect of body mass index on blood loss and complications in simultaneous bilateral total hip arthroplasty: A multicenter retrospective study

“…33 In addition, the calculating method (Gross and Nadler formula) is widely used in other studies. 26,34,35 Moreover, the calculating method is the same among the three groups, which is the basis of comparison. Therefore, we think the method to calculate blood loss in our study is suitable.…”

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

“…19,[47][48][49][50] The majority of included studies were RCTs, [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40]43,44,[46][47][48][49][50] while five were cohort studies including a control group. 19,34,41,42,45 The participants in most of the articles were undergoing elective surgery (n ¼ 3,563) 19-39,41--47,49,50 of which 13 studies investigated total knee arthroplasty patients which, at least partly, is an inflammatory condition (n ¼ 1,918), 20,22,24,25,27,34,35,[37][38][39]42,...…”