Efficacy and safety of intravenous tranexamic acid drips at different time points in bilateral primary total knee replacement

Abstract

Objective To investigate the effects of intravenous tranexamic acid (TA) drips at different time points on perioperative hemorrhage and postoperative venous thromboembolism (VTE) following bilateral primary total knee arthroplasty (TKA). Methods We reviewed 52 patients who had undergone primary bilateral TKA from February 2012 to February 2014. They were 25 men and 27 women, 50 to 75 years of age. They were divided into 4 even groups (n=13) according to timing of medication. Group A received a dose of 15 mg/kg TA intravenously 30 minutes preoperation and 30 minutes before wound closure; group B received a dose of 15 mg/kg TA intravenously 15 minutes preoperation; group C received 15 mg/kg TA intravenously 30 minutes before wound closure; group D received an equal volume of normal saline before surgery. The following indexes were recorded: 24 h postoperative drainage volume; total drainage volume; blood transfusion rate; postoperative haemoglobin (Hb) levels at 24 h, 72 h and 7 d; postoperative prothrombin time (PT); activated partial thromboplastin time (APTT); fibrinogen (FIB); visual analogue scale (VAS) at 24 h & 36 h postoperation; level of bilateral knee passive movement 3 days after surgery and VTE incidence. Patients' lower limbs were examined with Doppler ultrasound 2 weeks postoperatively. Results The 24h postoperative drainage volume and total drainage volume in groups A, B & C were significantly lower than in group D with group A being significantly less than groups B & C (P 0.05). No VTE occurred in any of the 4 groups. Conclusions In bilateral primary total knee arthroplasty, intravenous TA drips can reduce postoperative hemorrhage and blood transfusion rate but may not increase the risk of VTE or hinder passive movement rehabilitation of the knee early after the surgery. The intravenous infusion of 15 mg/kg of TA 30 minutes preoperation and 30 minutes before wound closure may lead to optimal efficacy. Key words: Tranexamic acid; Arthroplasty, replacement, knee; Postoperative hemorrhage; Embolism and thrombosis