Tranexamic acid attenuates inflammatory effect and modulates immune response in primary total knee arthroplasty: a randomized, placebo-controlled, pilot trial.

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To explore the effect of intravenous tranexamic acid (IV-TXA) on inflammation and immune response following primary total knee arthroplasty (TKA). Primary TKA patients (n = 125) were randomized into the following four groups: group A to receive placebo; group B to receive a single dose of 20mgkg-1 IV-TXA and 20mg of intravenous dexamethasone (IV-DXM); group C to receive six doses of IV-TXA (total dosage > 6g); and group D to receive six doses of IV-TXA combined with three doses of IV-DXM (total dosage = 40mg). The primary outcomes were C-reactive protein (CRP) and interleukin (IL)-6 levels and the secondary outcomes were complement C3 and C4 and T-cell subset levels, which were measured preoperatively and at 24h, 48h, 72h, and 2weeks postoperatively. The postoperative peak CRP and IL-6 levels in group C (93.7 ± 22.2mg L-1, 108.8 ± 41.7pgmL-1) were lower compared with those in group A (134.7 ± 28.8mg L-1, P < 0.01; 161.6 ± 64.4pgmL-1, P < 0.01). Groups B and D exhibited significantly lower CRP and IL-6 levels compared with groups A and C at 24h, 48h, and 72h postoperatively (P < 0.05 for all). In group C, complement C3 and C4 levels were higher compared with those in group A at 48h (0.967 ± 0.127g L-1 vs. 0.792 ± 0.100g L-1, P < 0.01; 0.221 ± 0.046g L-1 vs. 0.167 ± 0.028g L-1, P < 0.01) and 72h (1.050 ± 0.181g L-1 vs. 0.860 ± 0.126g L-1, P = 0.01; 0.240 ± 0.052g L-1 vs. 0.182 ± 0.036g L-1, P < 0.01) postoperatively and CD3 and CD4 subset levels were higher compared with those in group B at 24h postoperatively (66.78 ± 9.29% vs. 56.10 ± 12.47%, P < 0.05; 36.69 ± 5.78% vs. 28.39 ± 8.89%, P < 0.05). Six doses of IV-TXA could attenuate the inflammatory effect, modulate the immune response, and reduce immunosuppression caused by DXM in patients after TKA.