Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

Abstract

Background We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA). Methods For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50–75 years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1 g IV-TXA 10 min before skin incision, followed by articular injection of 1.5 g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay. Results The mean TBL, HBL, and maximum Hb level decrease in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in group A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 (P < 0.001), and the incidence of thromboembolic events was similar between the groups (P > 0.05). Conclusion In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900025013).

The efficacy and safety of tranexamic acid in rheumatoid arthritis patients undergoing simultaneous bilateral total knee arthroplasty: a multicenter retrospective study

“…A very few studies tried to explore whether TXA would decrease perioperative blood loss and whether TXA would add the risk of related complications in patients with RA following TKA [ 23 , 24 , 31 ]. A randomized controlled trail conducted by Kang et al showed that three doses of postoperative TXA further decreased TBL and HBL without increasing the incidence of adverse events in RA patients following primary TKA [ 23 ].…”

“…A very few studies tried to explore whether TXA would decrease perioperative blood loss and whether TXA would add the risk of related complications in patients with RA following TKA [ 23 , 24 , 31 ]. A randomized controlled trail conducted by Kang et al showed that three doses of postoperative TXA further decreased TBL and HBL without increasing the incidence of adverse events in RA patients following primary TKA [ 23 ]. Another study performed by Lei et al found that TXA use prior to surgery could dramatically diminish blood loss and transfusion requirement, decrease LOS and hospitalization expenses in patients with RA following primary TKA, without increasing the risk of complications [ 24 ].…”

“…However, the main concerns of previous studies were patients with osteoarthritis and the studies to evaluate the efficacy and safety of TXA in patients with RA were rare. Through extensive reading of relevant papers, we find that only a few literatures report the administration of TXA in patients with RA following primary TKA [ 23 , 24 ]. The research about TXA application in RA patients undergoing SBTKA is still absent.…”

Tranexamic acid in total knee arthroplasty

“…According to the National Joint Registry, more than 100,000 knee replacements are performed each year in England, Wales and Northern Ireland. Whilst most studies related to the use of TXA in knee surgery have examined blood loss in patients with osteoarthritis, it has proven to be efficacious in patients with rheumatoid arthritis [6], cancer [7] and in revision surgery [8]. Therefore, it seems reasonable to administer TXA to all patients requiring knee arthroplasty, irrespective of their underlying diagnosis.…”

The safety of tranexamic acid administration in total knee arthroplasty: a population‐based study from Taiwan

“…However, the optimal regimen for TXA infusion remains undetermined. For example, there are conflicting results regarding the effect of multiple and higher doses on blood loss reduction [13][14][15][16]. The impact of differential regimens, such as continuous infusion or single bolus; timing of administration; and route of administration require further evaluation.…”