Efficacy of different doses and timing of tranexamic acid in major orthopedic surgeries: a randomized trial

Abstract

BackgroundTranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication. MethodsTwo hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 patients each: Placebo, low dose (bolus 10mgkg−1), low dose+maintenance (bolus 10mgkg−1+maintenance 1mgkg−1hr−1), high dose (bolus 30mgkg−1) and high dose+maintenance (bolus 30mgkg−1+maintenance 3mgkg−1hr−1). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hours postoperatively. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period. ResultsThe intraoperative blood loss was 440±207.54mL in the placebo group, 412.5±208.21mL in the low dose group, 290±149.6ml in the low dose plus maintenance group, 332.5±162.33mL in the high dose group and 240.7±88.15mL in the high dose maintenance group (p<0.001). The reduction in postoperative blood loss in the drain for first 24hours was 80±44.44mL in the placebo group, 89.88±44.87mL in the low dose group, 56.7±29.12mL in the low dose plus maintenance group, 77.9±35.74mL in the high dose group and 46.7±19.9mL in the high dose maintenance group (p<0.001). DVT was not encountered in any patient. ConclusionTranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose+maintenance group.