Abstract
Introduction : Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and to decrease transfusion rates in patients undergoing TKA. Tranexamic acid is an antifibrinolytic agent with known efficacy for achieving these goals. Currently, many surgeons are performing TKA without the use of tourniquet. Consequently, the aim of the study is to evaluate whether tranexamic acid reduces blood loss during and after TKA without the adjunctive use of above-the-knee tourniquet.Methods : We performed a prospective randomized controlled trial (1:1 fashion) on the use of tranexamic acid versus placebo in 50 patients undergoing TKA (without tourniquet). The treatment group received two (preoperative and postoperative) 15 mg/kg doses. The primary endpoint was blood transfusion rate. We collected data about demographic and procedural characteristics, hemoglobin and hematocrit values, drain blood loss at 24 hours as well as adverse events.Results : There were no transfusions in the treatment group, whereas 32% of the control group required transfusion (p<0.01). The treatment group had higher hematocrit and hemoglobin levels at 24, 48 and 72 hours after surgery (all p<0.01) and lower drain loss at 24hours (363.4±141 vs 626±260ml, p=<0,001). There were no in-hospital or six-month thromboembolic complications.Discussion : A double-dose of tranexamic acid was safe and effective, reducing blood loss and preventing the need of blood transfusion in patients undergoing TKA without above-the-need tourniquet.
Highlights
Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions
Several studies have demonstrated that blood transfusion carries an excess risk of infections, arterial and venous thrombosis along with untoward immunologic reactions [17, 18]
Tranexamic acid affects the fibrinolytic system by inhibiting the proteolytic action of plasmin, which stabilizes clot formation and diminishes blood loss
Summary
Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and to decrease transfusion rates in patients undergoing TKA. The aim of the study is to evaluate whether tranexamic acid reduces blood loss during and after TKA without the adjunctive use of above-the-knee tourniquet. The widespread adoption of antiplatelet and anticoagulant agents to reduce thromboembolic events in patients undergoing TKA has considerably increased bleeding risk. We are not aware of any prospective, randomized, controlled trial that has evaluated the efficacy of tranexamic acid in reducing blood loss in patients undergoing TKA without the adjunctive use of pneumatic tourniquet. We designed a randomized controlled study to evaluate the use of this agent in patients undergoing TKA without tourniquet. The primary outcome measure was transfusion rate, secondary outcome measures were drain output, hemoglobin/hematocrit levels
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