The effect of oral tranexamic acid administration on blood loss and hospital costs in patients undergoing total knee arthroplasty

Abstract

Aim:Total knee arthroplasty is a kind of major orthopaedic operation that may go with serious amount of peroperative blood loss. Tranexamic acid administration (an antifibrinolytic agent) is one of the most common strategy among the various blood preserving strategies used in major surgeries associated with high volume blood loss. The aim of this study is to evaluate effectiveness of oral tranexamic acid in reducing blood loss and blood transfusion in total knee arthroplasty procedures. In addition hospital costs were also compared.Materials-Methods:Between 2013-2016, 256 total knee arthroplasty procedure performed by six different staff surgeons in our clinic. 125 patients appropriate for our study criteria were included in our study and retrospectively evaluated. 49 patients in study group were administered 15 mg/kg tranexamic intravenous infusion before relasing intraoperative tourniquet and continued as oral 500 mg tranexamic acid three times with 6 hours interval in the first postoperative 24 hours.76 patients were not administered tranexamic acid and compromised the control group. Information on pateints’s demographics, preoperative and postoperative 24th hour hemoglobin and hematocrit values, postoperative 24th hour drain volumes and blood transfusions were obtained from patient files retrospectively.Results:Postoperative 24th hour drain volumes were significiantly less in tranexamic acid administered group (283 130 cc) than that of control group (383 135 cc) (p<0,001). Decrease in hemoglobin and hematocrit values in the postoperative 24th hour were significiantly less in study group (1,73 g/dL-%6,13) than those of control group (2,92 g/dL -%8,63) (P<0,001). Both number of total erythrocyte suspensions (ES) transfused and number of patients transfused were higher in control group than those of study group. (52 ES and 45 patients versus 18 ES and 14 patients) Calculated average ES per patient were 0.37 in study group and 0.68 in control group. (P=0,009). As a result blood bank costs were reduced %50 in study group as compared to control group.Conclusions:Tranexamic acid administered as single intraoperative intravenous dose and sequentially continued as 500 mg oral dosage 3 times with six hours interval in the first postoperatve24 hours is a significiantly effective approach in preventing bloos loss and reducing hospital costs in total knee arthroplasty procedures. In addition easiness and convinience of oral administration of tranexamic acid makes the approach more advantageous.