Effectiveness and Safety of Tranexamic Acid for Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Abstract

BackgroundTotal knee arthroplasty (TKA) is associated with significant perioperative blood loss and need for transfusion. This study aimed to evaluate the effectiveness and safety of tranexamic acid (TXA) to reduce perioperative blood loss in patients receiving TKA.Material/MethodsA total of 92 patients who accepted unilateral TKA from May 2012 to May 2013 randomly received either 15 mg/kg TXA in 100 mL normal saline solution (TXA group, n=46) or the same amount of normal saline solution (placebo group, n=46) at 15 min before the tourniquet was loosened. The following data were recorded: intraoperative blood loss; post-operative drainage at 12 h; total drainage amount; hidden blood loss; total blood loss; transfusion volumes; number of transfusions; post-operative hemoglobin at 1, 3, and 5 days; D-dimer; number of lower limb ecchymoses; and deep vein thrombosis (DVT).ResultsA total of 81 patients were available for analysis (TXA group, n=41; placebo group, n=40). Post-operative12-h drainage, post-operative 24-h D-dimer values, total drainage volume, hidden blood loss, total blood loss, and the rate of postoperative ecchymosis were lower in the TXA group than in the placebo group (p<0.05). The post-operative 3-day Hgb was higher in the TXA group than in the placebo group (p=0.000). The rate of transfusion and DVT was similar in both groups (n.s.).ConclusionsPerioperative blood loss could be reduced after TKA by intravenously injecting 15 mg/kg TXA at 15 min before the tourniquet was loosened. The application of TXA is not associated with increased risk of DVT.

Management of severe perioperative bleeding

“…There is growing evidence for the well tolerated and beneficial use of tranexamic acid to reduce perioperative blood loss, allogeneic blood transfusions and associated costs in major orthopaedic surgery such as total hip or knee arthroplasty, and spine surgery. [313][314][315][316][317][318][319][320][321][322][323][324][325][326] However, tranexamic acid is not recommended in patients with hypersensitivity or allergy to the drug, history of venous or arterial thrombosis, or thrombophilia, cardiovascular disease, acute renal failure or subarachnoid haemorrhage, or in patients with a history of seizures or epilepsy. 327 There is emerging evidence that topical administration of tranexamic acid may be beneficial in reducing the rate of blood transfusions in both total hip replacement and total knee replacement surgery.…”

Use of tranexamic acid in total knee arthroplasty

“…similarly, Maniar et al, also in a randomized controlled trial, demonstrated that a three-dose regimen (adding a postoperative dose) may be even more effective (32). Most of the studies confirmed the efficacy of different doses of iV tXA in reducing transfusion rates and total blood loss (27,(33)(34)(35)(36)(37)(38)…”

The Use of Transexamic Acid for Total Hip Arthroplasty in Chronic Hemodialysis Patients

“…Интраоперационная кровопотеря неминуемо приводит к усугублению имеющейся анемии в послеоперационном периоде [5], т. е. состояния, которое требует трансфузии компонентов крови [6]. Это, в свою очередь, удлиняет средний срок пребывания больного в стационаре и увеличивает стоимость лечения [7].…”