Is there an optimal timing of administration of single-dose intravenous tranexamic acid in bilateral total knee arthroplasty? A comparison between preoperative and intraoperative dose

Abstract

Purpose: There is no consensus on the optimum timing of administration of tranexamic acid (TA) in bilateral total knee arthroplasty (TKA). We aimed to determine whether the timing of administration of single-dose intravenous TA (either given preoperatively or intraoperatively) has a significant effect on blood loss reduction. Methods: We compared two cohorts of patients with end-stage arthritis of knees who underwent bilateral TKA and were given single-dose intravenous TA (1 g or 15 mg/kg) at different times during surgery. The retrospective cohort group consisting of 40 patients (preoperative (PO) group) received TA before the skin incision. The prospective cohort consisting of 40 patients (intraoperative (IO) group) received TA 10 min before deflating the tourniquet on the first knee. Primary outcome measures were mean hemoglobin difference, A (between PO and day 1 postoperative hemoglobin), mean hemoglobin difference, B (between PO and lowest postoperative hemoglobin), and rate of allogeneic blood transfusion. Secondary measure was drain blood loss. Results: Both cohorts were well matched with respect to age, gender, duration of surgery, and length of hospital stay. The hemoglobin drop in the IO group was significantly lesser than the PO group on the first postoperative day (2 vs. 2.9 g/dL, p < 0.001). Although statistically insignificant, the patients in the IO group received less allogenic transfusion of packed cell units than in the PO group (11/40, 27.5% vs. 14/40, 35% ). Mean hemoglobin difference, B, and secondary drain loss were comparable in both groups. Conclusion: Single-dose intravenous TA given before the start of surgery is as effective as a dose given during arthroplasty of the first knee in reducing blood loss in bilateral TKA.

Does tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis

“…The findings indicated that receiving an IV injection of TXA during surgery resulted in a notably lower reduction in hemoglobin levels on the first day following the operation. However, there was no substantial impact on the need for transfusions or the amount of fluid drainage [ 43 ]. It is assumed that TXA operates under the all-or-nothing rule, which means that the drug is ineffective if its serum concentration falls below a certain threshold.…”

Does Tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis

“…The ndings indicated that receiving an IV injection of TXA during surgery resulted in a notably lower reduction in hemoglobin levels on the rst day following the operation. However, there was no substantial impact on the need for transfusions or the amount of uid drainage [29]. It is assumed that TXA operates under the all-or-nothing rule, which means that the drug is ineffective if its serum concentration falls below a certain threshold.…”

Utilization of Tranexamic Acid in Surgical Orthopaedic Practice: Indications and Current Considerations

“… 76 A prospective cohort study by Balachandar and Abuzakuk explored the use of preoperative versus intraoperative single dose of IV TXA in patients undergoing bilateral TKA and noted that while patients in the intraoperative group had a significantly lesser decrease in hemoglobin on the first day postoperatively, no significant difference was appreciated with respect to transfusion rates and drain blood loss volume. 77 …”