Six-Dose Intravenous Tranexamic Acid Regimen Further Inhibits Postoperative Fibrinolysis and Reduces Hidden Blood Loss following Total Knee Arthroplasty

Abstract

There is no consensus regarding the ideal dosages and times of multiple-dose intravenous tranexamic acid (IV-TXA) administration in total knee arthroplasty (TKA). This study aimed to assess the effect of six-dose IV-TXA with the total dosage more than 6 g on postoperative fibrinolysis and hidden blood loss (HBL) after primary TKA. A total of 175 patients were randomized into three groups to receive placebo (group A), or a single preoperative dose of 20 mg/kg IV-TXA (group B), or six-dose IV-TXA from the beginning of the procedure to subsequent 24 hours with the total dosage more than 6 g (group C). The calculated HBL, maximum hemoglobin (Hb) drop, transfusion rate, and the incidence of thromboembolic events were compared among groups. The levels of fibrinolysis parameters in plasma including fibrin(-ogen) degradation products (FDP) and D-dimer were measured at six time points from preoperatively to 3-month postoperative period. The mean HBL and maximum Hb drop in group C (515.51 ± 245.79 mL, and 2.06 ± 0.73 g/dL, respectively) were significantly lower than those in groups B (756.06 ± 226.79 mL, p < 0.001; and 2.77 ± 0.78 g/dL, p < 0.001, respectively) and A (987.65 ± 275.38 mL, p < 0.001; and 3.49 ± 0.86 g/dL, p < 0.001, respectively). Such differences were also detected between groups A and B (p < 0.001 and p < 0.001, respectively). The levels of FDP and D-dimer in plasma were lower in group C than those in groups B and A on postoperative 24, 48, 72 hours (p < 0.001 for all). No episode of transfusion occurred, and the incidence of thromboembolic events were similar among groups (p > 0.05). The administration of six-dose IV-TXA during the first 24 hours resulted in reduced HBL following TKA without a measured increase in thromboembolic events.

Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

“…Lei et al [58] reach the same conclusion by comparing 20 mg/kg and 60 mg/kg TXA intravenously. Moreover, Zhang et al [52] even reported a better outcome of six-dose IV TXA. Besides, Tammachote et al [59] compared high dosage (3 g) with low dosage (0.5 g) for IA TXA and also found a better outcome of high dosage.…”

“…Besides, the DVT rate might be influenced by the inclusion criteria, and the RCT of TXA in a DVT high-risk population might be required to validate our findings. Furthermore, repeated dose seemed a better choice than a single dose in both IV and IA administration [52,[57][58][59], and therefore, different methods of administration may influence the result. Lastly, data for Fig.…”

Comparison of oral versus intravenous tranexamic acid in total knee and hip arthroplasty

“…The most common IV TXA dose appears to be approximately 10 to 20 mg/kg, which has been shown to maintain the minimum therapeutic level for approximately 3 hours. [ 36 , 37 ] The oral dose usually ranged from 1 g to 4 g, and the time to the administration of TXA ranged from 1 hour to 8 hours before surgery. [ 37 ] The most common oral TXA dose was 2 g, and the time to administration was 2 hours before surgery.…”

Multiple-Dose Intravenous Tranexamic Acid in Total Knee Arthroplasty in Patients with Rheumatoid Arthritis: A Randomized Controlled Study

“…The safety of multiple doses of TXA in OA patients undergo TKA has been con rmed by some studies. [15,31,32] To our acknowledge, this study was the rst study to observe the clinical effect of multi-dose TXA after TKA in patients with RA. We used 3 doses of IV-TXA (1 g) after surgery, the anti brinolytic effect was maintained in the whole process of brinolysis, the HBL, the drop in Hct and Hb during hospitalization was lower than that of single dose.…”