Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study

Turgut Akgül, Mehmet Büget, Ahmet Salduz, İpek S Edipoğlu, Mehmet Ekinci, Süleyman Küçükay, Cengiz Şen, Turgut Akgül, Mehmet Büget, Ahmet Salduz, İpek S Edipoğlu, Mehmet Ekinci, Süleyman Küçükay, Cengiz Şen

Abstract

Objective: The aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total knee arthroplasty (TKA).

Material and method: 70 patients (65.5 ± 8.1 years old) that have undergone TKA were divided in two groups. The 20 mg/kg IV TXA was given before the skin incision to one group (study group). On the control group, TKA was performed without TXA. The demographic data, body mass index, amount of bleeding and erythrocyte infusion during the operation, hemoglobin and hematocrit values (preoperative and 48th hour), the amount of drainage after the operation were compared between the groups.

Results: The total amount of bleeding in the study group was 634.03 ± 182.88 ml and 1166.42 ± 295.92 ml in the control group (p < 0.001). Perioperative bleeding was 252.01 ± 144.13 ml in the study group and 431.33 ± 209.10 ml in the control group (p = 0.018). The drainage after the operation was 311.11 ± 141.64 ml at the 24th hour in the study group, 640.74 ± 279.43 ml at the 24th hour in the control group (p < 0.001). The drainage after 24th hour was 97.96 ± 115.86 ml in the study group and 112.96 ± 64.43 ml in the control group (p = 0.584).

Conclusion: A high, single dose of TXA intravenously given to the patient prior to the TKA significantly reduces the bleeding during the operation and within the postoperative 24 h. There is no significant change in the bleeding amount after the 24th hour following the operation.

Keywords: Peroperative bleeding; Postoperative bleeding; Total knee arthroplasty; Tranexamic acid.

Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

References

    1. Morais S., Ortega-Andreu M., Rodriguez-Merchan E.C. Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop. 2014;38:347–354.
    1. Ma J., Huang Z., Shen B., Pei F. Blood management of staged bilateral total knee arthroplasty in a single hospitalization period. J Orthop Surg Res. 2014;9:116.
    1. Keska R., Paradowski T.P., Witonski D. Outcome in primary cemented total knee arthroplasty with or without drain: a prospective comparative study. Indian J Orthop. 2014;48:404–409.
    1. Sasanuma H., Sekiya H., Takatoku K., Takada H., Sugimoto N., Hoshino Y. Efficient strategy for controlling postoperative hemorrhage in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19:921–925.
    1. Shaieb M.D., Watson B.N., Atkinson R.E. Bleeding complications with enoxaparin for deep venous thrombosis prophylaxis. J Arthroplast. 1999;14:432–438.
    1. Liu F., Chu X., Huang J., Tian J., Hua J., Tong P. Administration of enoxaparin 24 h after total knee arthroplasty: safer for bleeding and equally effective for deep venous thrombosis prevention. Arch Orthop Trauma Surg. 2014;134:679–683.
    1. Goodnough L.T. Risks of blood transfusion. Anesthesiol Clin N Am. 2005;23:241–252.
    1. Orpen N.M., Little C., Walker G., Crawfurd E.J. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee. 2006 Mar;13:106–110. Epub 2006 Feb 17.
    1. Jung W.H., Chun C.W., Lee J.H., Ha J.H., Kim J.H., Jeong J.H. No difference in total blood loss, haemoglobin and haematocrit between continues and intermittent wound drainage after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21:2831–2836.
    1. Ishida K., Tsumura N., Kitagawa A. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011;35:1639–1645.
    1. Nielsen R.E., Husted H. Tranexamic acid reduces blood loss and the need of blood transfusion after knee arthroplasty. Ugeskr Laeger. 2002:14;164:326–329.
    1. Hiippala S., Strid L., Wennerstrand M., Arvela V., Mantyla S., Ylinen J. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth. 1995;74:534–537.
    1. Moskal J.T., Harris R.N., Capps S.G. Transfusion cost savings with tranexamic acid in primary total knee arthroplasty from 2009 to 2012. J Arthroplast. 2015 Mar;30:365–368.
    1. Wu Q., Zhang H.A., Liu S.L., Meng T., Zhou X., Wang P. Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials. Eur J Orthop Surg Traumatol. 2015 Apr;25:525–541.
    1. Hardy J.F., Desroches J. Natural and synthetic antifibrinolytics in cardiac surgery. Can J Anaesth. 1992;39:353–365.
    1. Hourlier H., Reina N., Fennema P. Single dose intravenous tranexamic acid as effective as continuous infusion in primary total knee arthroplasty: a randomised clinical trial. Arch Orthop Trauma Surg. 2015;135:465–471.
    1. Maniar R.N., Kumar G., Singhi T., Nayak R.M., Maniar R.P. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012;470:2605.
    1. Lin Sung-Yen, Chen Chung-Hwan, Fu Yin-Chih, Huang Peng-Ju, Chang Je-Ken, Huang Hsuan-Ti. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty. J Arthroplast. 2015;30:776–780.
    1. Zhang H., Chen J., Chen F., Que W. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta- analysis. Knee Surg Sports Traumatol Arthrosc. 2012;20:1742–1752.
    1. Senthil Kumar G., Von Arx O.A., Pozo J.L. Rate of blood loss over 48 hours following total knee replacement. Knee. 2005;12:307–309.
    1. Gillette B.P., DeSimone L.J., Trousdale R.T., Pagnano M.W., Sierra R.J. Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty. Clin Orthop Relat Res. 2013;471:150–154.

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