Intra-articular Tranexamic Acid Research Articles

Evaluation of efficacy and safety of systemic and topical intra-articular administration of tranexamic acid in primary unilateral total hip arthroplasty.

Background:Tranexamic acid (TXA) is an antifibrinolytic agent used to reduce bleeding in major surgical procedures. This study evaluates the efficacy and safety of the systemic and topical intra-articular administration of TXA in total hip arthroplasty (THA).Methods:Patients (N = 123) scheduled for primary unilateral THA were divided into 3 treatment groups: control group; TXA, systemic, repeated 1 g bolus; TXA, topically intra-articularly, 2 g in 50 mL saline. Primary readouts used were intra- and postoperative bleeding, transfusion requirement, postoperative hemoglobin levels and complications.Results:Both systemic and topical intra-articular TXA administrations decreased bleeding and transfusion requirements. Topical intra-articular use of TXA led to the reduction in intraoperative and postoperative bleeding and affected hemoglobin levels compared with control. Systemic administration of TXA led to a significant reduction of postoperative bleeding and transfusion rate compared with control and was not different in efficacy and complication incidence when compared to topical administration of TXA.Conclusions:The use of TXA to reduce blood loss and transfusion requirements in THA is an effective and safe concept in practice. The dose of 2 g TXA topically intra-articularly and a repeated bolus of 1 g TXA systematic led to lower intra- and postoperative bleeding and a significantly lower transfusion rate than the control group. Topical intra-articular TXA administration could be a reasonable alternative in high-risk patients.

Comparison of Intra-Articular versus Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

Background: Total Knee Arthroplasty (TKA) is widely used in clinical applications. Considerable postoperative blood loss, however, is an unavoidable occurrence due to the extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. Besides, knee flexion and extension activities those begin the day after the operation adds to the problem. Aim of the Work: To compare between the intra-articular and the intravenous application of Tranexamic Acid (TXA) in total knee arthroplasty. Patients and Methods: It is a prospective Double-blinded Randomized controlled trial. This prospective study was conducted at El-Hussein University Hospital & El Agouza Hospital on 30 patients who undergo total knee arthroplasty and fulfill all inclusion and exclusion criteria. Results: The results were the average total blood loss in the drain after 48hrs. In the 1st group was 365±74.722 while average blood loss in the 2nd group was 575±88.976. This indicates a significant decrease in blood loss in the 1st group (intraarticular TXA group) than the 2nd group (intravenous TXA group) the P value <0.001 which is highly significant. It was found that The decrease in Hb level is less in the 1st group than in the 2nd group which indicates less postoperative anemia in the blood count, the P-value <0.05 considered significant.

Influence of intra-articular tranexamic acid on cost savings and early functional outcomes in total knee arthroplasty

Background and aimTotal knee arthroplasty (TKA) is a frequent intervention that can associate significant blood loss. There are several methods to avoid transfusions. One of the most relevant is tranexamic acid (TXA). Our purpose is to analyse the efficacy in terms of blood savings, transfusion needs, functional results, and cost-effectiveness of intra-articular (IA) administration in TKA. Materials and methodsWe conducted a retrospective analysis of historical cohorts (75 patients each) between January 2015 and December 2016. We included 150 patients (59,3% women) with a mean age of 73,58 years. The intervention consisted of administering 2 g of IA TXA with a contact time of 30 min. Demographic data, preoperative haematological status, surgery data, estimated total blood loss (ETBL), need for transfusion, functional results, and cost analysis were collected. The level of statistical significance was p ≤ 0,05. ResultsThe incidence of transfusion was 17,33% in the control group and 5,33% in the TXA group (p = 0,039), with a relative risk reduction of 78,3%. The TXA cohort showed a reduction in ETBL (p < 0,0005), units transfused (p = 0,019) and length of stay (p = 0,004). All early functional parameters also improved, including a 10° improvement in both flexion and extension (p < 0,0005). The use of IA TXA resulted in savings of 337,78 € per patient. ConclusionsIn our experience, the administration of IA TXA in TKA is a cost-effective and efficient measure in terms of blood savings and immediate postoperative functional improvement.

Investigation of the Effects of Intra-articular Tranexamic Acid on Intact Cartilage Tissue and Cartilage Formation in Osteochondral Defects of the Rabbit Knee: An Experimental Study.

BackgroundIn this study, the effects of tranexamic acid (TXA) and saline on intact cartilage and the recovery of experimental osteochondral lesions following microfracture in a rabbit model were compared.MethodsTwenty adult rabbits were divided into four groups (1A, 1B, 2A, and 2B) based on with or without TXA use and microfracture. In addition, these groups were categorized into two different subgroups based on the use of TXA in Groups 1 and 2 (Groups A and B). Full-thickness cartilage defects were created on the weight-bearing surface of the medial femoral condyles unilaterally in Group 2 for the effect of TXA or saline on healthy cartilage tissue while a repetitive injection was applied in Group 1 for the effect of TXA or saline on intact cartilage. A single dose of 10 mg/kg TXA was injected into the knee joints of Group A and 10 mg/kg 0.9% saline solution injected in Group B for three consecutive days. All animals were sacrificed for the extraction of the medial condyles for histologic evaluation eight weeks after surgery. The International Cartilage Repair Society (ICRS) II scoring system was used for histologic evaluation.ResultsNo complications or adverse effects related to surgery were observed in all rabbits. All ICRS II parameters were similar in the TXA and saline solution groups in the intact cartilage group except for chondrocyte clustering, formation of a tidemark, subchondral bone abnormalities, and mid/deep zone assessment. Moreover, these parameters were higher in the saline solution group in the cartilage group, but no significant difference was observed in the TXA group in the intact cartilage group. All ICRS II parameters were higher in the saline solution group than in the TXA group in the microfracture group, but no significant difference was observed in the TXA group in the microfracture group except for inflammation, which was similar in the TXA and saline solution groups in the microfracture group.ConclusionWe found that intra-articular TXA administration did not have a negative impact on healthy cartilage tissue and cartilage transformation and proliferation as compared to the saline infusion.

El ácido tranexámico tópico, intravenoso y su uso combinado son equivalentes en la reducción de la pérdida sanguínea tras la artroplastia total de cadera primaria

ObjectiveTo determine the equivalence of tranexamic acid (TXA) administration topically, intravenously or the combination of both routes are equivalent in reducing blood loss after primary total hip arthroplasty. Material and methodsIn this prospective study, we divided 285 total hip arthroplasty into 4 groups. Group A received 2,5g of intraarticular topical TXA, Group B did not receive TXA, Group C received 1g intravenous TXA and group D a combination of topical and intravenous TXA. The main outcome was blood loss according to Nadler's formula and total hemoglobin. ResultsBlood loss was significantly greater in Group B (Group A. 797.13ml; Group B: 1,308.24; Group C: 986.30 and Group D: 859.09ml; P<.01) with no differences between the other groups. Hemoglobin loss was greater in Group B (11.81, 19.46, 14.52 and 12.78 respectively, P<.001). Two patients (3,1%) were transfused in Group A, 4 (5,3%) in Group B, 3 (3,4%) in Group C, and 1 (1,8%) in Group D (P=.75). The mean reduction in hemoglobin at 48hours was less in the topical Group (P<.05). In comparison with Group B the mean reduction in hemoglobin after 48hours was greater (P<.001) and we can also see a longer hospital stay (P<.001). One patient in Group A presented pulmonary thromboembolism 72hours after surgery, which was resolved without complications. ConclusionsThe administration of TXA topically, intravenously or in combination in primary total hip arthroplasty, is a simple and safe procedure that provides equivalent reductions in hemoglobin and blood loss.

Intravenous versus Intra-Articular Tranexamic Acid in Primary Total Hip Arthroplasty: A Prospective Randomised Double Blinded Non-Inferiority Trial

Introduction&#x0D; Tranexamic acid (TXA) has been shown to be effective in reducing post-operative blood loss after hip replacement surgery. Clinicians can be reluctant to administer intravenous (IV) TXA to high risk patients and intra-articular (IA) administration has been proposed as an alternative mode of delivery. This study was conducted to compare the efficacy of IV versus IA administration of TXA.&#x0D; &#x0D; Methods&#x0D; This prospective, double blinded, randomised non-inferiority trial, compared 69 patients undergoing primary total hip arthroplasty (THA) who received either 3 doses of 15mg/kg of IV TXA or 3 g of IA TXA after capsular closure. The primary outcomes were change in Hb and the rate of blood transfusion. The secondary outcome was the rate of VTE.&#x0D; &#x0D; Results&#x0D; The mean haemoglobin level change from pre-operative to day 1 post-operative for the IV group was 26.7g/L and for IA group was 27.3g/L. No statistically significant difference was detected between the two groups (p=0.82). No patients required a transfusion or developed a VTE.&#x0D; &#x0D; Conclusions&#x0D; IA administration of TXA can be equally effective as IV in the reduction of blood loss and the prevention of post-operative anaemia in primary THA.

Should We Use Intra-articular Tranexamic Acid Before or After Capsular Closure During Total Knee Replacement? A Study of 100 Knees.

Intraarticular (IA) administration of tranexamic acid (TXA) is a proven way of reducing blood loss in total knee replacement (TKR). However, different methods of administration have been described in literature such as placement of an intra-articular swab soaked in TXA before capsular closure or injecting TXA intraarticularly after capsular closure. We decided to compare these two methods. One hundred consecutive patients planned for unilateral TKR between December 2018 and March 2019 were selected for the study and divided into 2 groups of 50 patients each. All patients received IV and oral TXA identically-15mg/kg TXA IV preoperatively, 10mg/kg IV TXA at 3 and 6h postoperatively, and 1g oral TXA for the next 2days. Group A was given IA TXA via swab soaked with 1g TXA in 100ml normal saline (NS) before closure of arthtrotomy, while Group B was given 1g of IA TXA via injection in the knee after capsular closure. Preoperative haemoglobin (Hb) and postoperative day 4 Hb values were measured. Blood loss was calculated and compared in both groups using Mann Whitney test. The mean blood loss was 652.23 ± 64.36ml in Group A and 542.68 ± 266.23ml in Group B. The difference in blood loss between both groups was found to be clinically significant with a p-value of 0.03236 (significant, p < 0.05). Injecting TXA intraarticularly after capsular closure is more effective than using an intra-articular swab containing TXA. Level III Retrospective Comparative study.

Influencia del ácido tranexámico intraarticular sobre el ahorro de costes y los resultados funcionales precoces en artroplastia total de rodilla

Background and aimTotal knee arthroplasty (TKA) is a frequent intervention that can associate significant blood loss. There are several methods to avoid transfusions. One of the most relevant is tranexamic acid (TXA). Our purpose is to analyse the efficacy in terms of blood savings, transfusion needs, functional results, and cost-effectiveness of intra-articular (IA) administration in TKA. Materials and methodsWe conducted a retrospective analysis of historical cohorts (75 patients each) between January 2015 and December 2016. We included 150 patients (59.3% women) with a mean age of 73.58 years. The intervention consisted of administering 2 g of IA TXA with a contact time of 30 minutes. Demographic data, preoperative haematological status, surgery data, estimated total blood loss (ETBL), need for transfusion, functional results, and cost analysis were collected. The level of statistical significance was p ≤ 0,05. ResultsThe incidence of transfusion was 17.33% in the control group and 5.33% in the TXA group (p = 0.039), with a relative risk reduction of 78.3%. The TXA cohort showed a reduction in ETBL (p < 0.0005), units transfused (p = 0.019) and length of stay (p = 0.004). All early functional parameters also improved, including a 10° improvement in both flexion and extension (p < 0.0005). The use of IA TXA resulted in savings of 337.78 € per patient. ConclusionsIn our experience, the administration of IA TXA in TKA is a cost-effective and efficient measure in terms of blood savings and immediate postoperative functional improvement.

The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction for reducing postoperative hemarthrosis: a prospective randomized study

BackgroundHemarthrosis after anterior cruciate ligament (ACL) reconstruction can create many adverse joint effects. Tranexamic acid (TXA) can be used to minimize hemarthrosis and associated pain after ACL reconstruction. We aimed to compare the efficacies of intravenous (IV) administration and intra-articular (IA) injection of TXA during ACL reconstruction for reducing postoperative hemarthrosis.MethodsA total of 120 patients who underwent arthroscopic ACL reconstruction were included in this prospective and randomized study. All patients were randomized into three groups: IV group, IA group and placebo group. Patients in the IV group received intravenously administered TXA (15 mg/kg in 100 mL of saline solution) 10 min before tourniquet release; patients in the IA group received intra-articular TXA (15 mg/kg in 100 mL of saline solution) injected via the drainage tube; and patients in the placebo group received an equivalent volume of normal saline administered into the knee joint cavity and intravenously. Drainage tubes were removed 24 h after surgery, and all enrolled patients experienced a 4-week follow-up period. The drain output volume, visual analogue scale (VAS) score, patellar circumference, hemarthrosis grade and Lysholm score of all patients were recorded.ResultsBoth the IV group and the IA group had significantly lower drain output volumes at day 1, lower VAS scores at weeks 1 and 2, smaller patellar circumferences at weeks 1 and 2, and lower hemarthrosis grades at weeks 1 and 2 than the placebo group (p < 0.05). There were no significant differences in drain output volume, VAS score, patellar circumference or hemarthrosis grade between the IV group and the IA group at any time point (p > 0.05). No obvious differences in Lysholm score were observed between any pair of groups at week 4 (p > 0.05)). Neither infection nor deep vein thrombosis occurred in any group.ConclusionsBoth intravenous administration and intra-articular injection can reduce intra-articular hemarthrosis, joint pain and swelling during ACL reconstruction. No significant difference in the efficacies of reducing hemarthrosis, joint pain and swelling was found between intravenous administration and intra-articular injection.Trial registrationThe study was registered by the Chinese Clinical Trial Registry (The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction; ChiCTR-INR-17012217; August 1, 2017).

Efficacy of topical versus intravenous tranexamic acid in bilateral total knee arthroplasty

IntroductionMultiple strategies, used either in isolation or combination, are available to reduce the need for post-operative blood transfusion in joint replacements. Amongst them, the use of tranexamic acid (TXA) has been rising and this study was conducted to compare the efficacy of topical and intravenous TXA in bilateral total knee replacement patients. Materials and methodsRandomised prospective study with 120 patients (male: female: 25:95) undergoing bilateral TKA. Patients were divided into two groups A and B after computer randomization, who received intravenous or topical (intra-articular) TXA respectively. ResultsThe average haemoglobin loss in intravenous group was 90.2379 g/L as compared to 39.137 g/L in topical group (p < 0.005).Moreover, there was reduction in blood loss in topical (330.1602 ml) as compared to intravenous group (764.9622 ml). The blood transfusion rate was more for the intravenous group (average 1.73 units) than for the topical group (average 0.75, unit). WOMAC score at 6 weeks in the intravenous group was 12.50, and in the topical group was 7.23 (p value < 0.001). ConclusionTopical TXA is better than intravenous TXA for reduction of blood loss, which also reduces the need for blood transfusion in bilateral TKA patients.

Advantages of Intra-Articular Tranexamic Acid Injection Following Simultaneous Bilateral Primary Total Knee Arthroplasty

Advantages of Intra-Articular Tranexamic Acid Injection Following Simultaneous Bilateral Primary Total Knee Arthroplasty

Use of tranexemic acid on postoperative blood loss and transfusion requirements in patients undergoing total knee replacement

Use of tranexemic acid on postoperative blood loss and transfusion requirements in patients undergoing total knee replacement - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.064, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Comparative study between the hemoprophylaxis provided by intra-articular and intravenous tranexamic acid in total knee arthroplasty

Patients undergoing Total knee arthroplasty (TKR) are transfused at the rates of 11-21%. As per ISHKS joint registry, data of 34,478 TKRs was assessed: Average age was 64.4 years These Geriatric patients are exposed to complications as a result of major orthopedic surgery and postoperative anemia, which exposes the patient to the complications associated with transfusion as well as increasing their duration of hospital stay. Geriatric patients are prone to existing comorbidities and are susceptible to risk factors, predisposing to Venous Thromboembolism (VTE). In our single center based short series study, we look to compare the efficacy of hemoprophylaxis provided by intravenous & intra-articular tranexamic acid. Our aim is to find an effective protocol to reduce postoperative anemia whilst minimising risk of VTE’s. Keywords: TKA, Tranexamic acid, Chemoprophylaxis.

Effect of Multiple Doses of Intravenous Tranexamic Acid on Perioperative Blood Loss in Total Knee Arthroplasty: A Randomized Controlled Study

ObjectiveTo identify the efficacy and safety of multiple doses of intravenous tranexamic acid (IV‐TXA) following primary total knee arthroplasty (TKA) with a tourniquet.MethodsThis is a single‐blind randomized controlled study that recruited osteoarthritis patients who had undergone primary unilateral TKA from May 2019 to May 2020 at our medical center. A total of 300 patients were randomly divided into three groups to receive: one dose (1 g) of IV‐TXA before skin incision combined with one dose (1.5 g) of intra‐articular tranexamic acid（IA‐TXA) followed by a single dose of IV‐TXA (1 g) for 3 h (group A); two doses of IV‐TXA (1 g) for 3 and 6 h (group B); or three doses of IV‐TXA (1 g) for 3, 6, and 12 h (group C) postoperatively. TKA with a tourniquet was performed by the same surgical team. The primary outcomes were total blood cell loss (TBL), hidden blood loss (HBL), maximum hemoglobin (Hb) drop, and transfusion rate. Secondary outcomes were levels of C‐reactive protein (CRP) and D‐dimer, and the incidence of postoperative complications. One‐way analysis of variance, subgroup analysis, and multivariate correlation analysis were used to calculate the differences among the three groups.ResultsThe study included 56 male and 244 female patients aged 60–80 years. The mean TBL, the mean HBL, and the maximum Hb drop in group C (471.2 ± 190.6 mL, 428.4 ± 190.3 mL, and 21.2 ± 3.8 g/L, respectively) were significantly lower than those in groups B (563.4 ± 224.6 mL, P = 0.030; 519.9 ± 226.4 mL, P = 0.033; and 23.2 ± 4.1 g/L, P = 0.001, respectively), and A (651.6 ± 254.1 mL, P < 0.001; 607.1 ± 254.3 mL, P < 0.001; and 25.1 ± 4.3 g/L, P < 0.001, respectively). No transfusions were required. The postoperative acute inflammatory reaction was less problematic for patients in Group C, and the incidence of thromboembolic events was similar among the groups (P > 0.05). In addition, there were positive correlations between the HBL and the tourniquet inflation time (r = 0.844, P < 0.001). Similarly, the level of CRP on POD1 (r = 0.393, P < 0.001) and POD3 (r = 0.149, P = 0.010), and the level of D‐dimer on POD1 (r = 0.382, P < 0.001) were positively correlated with the HBL.ConclusionThree doses of postoperative IV‐TXA decreased blood loss and diminished the postoperative inflammatory and fibrinolytic response more than a single dose or two doses in elderly patients following TKA without increasing the incidence of adverse events.

Prospective randomized trial comparing efficacy and safety of intravenous and intra-articular tranexamic acid in total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) is associated with significant perioperative blood loss and postoperative allogenic blood transfusion. Tranexamic acid (TXA) reversibly blocks lysine binding sites on plasminogen molecules and inhibits plasmin formation. Comparisons of the efficacy and safety of intra-articular and intravenous TXA in primary TKA have not previously been reported.MethodsA prospective randomized trial was conducted in 150 patients who underwent TKA, and these patients were randomized into three groups. Patients in Group A were injected by intra-articular TXA according to body weight (20 mg/kg). Patients in Group B received a standard dose of intra-articular TXA (2000 mg), and those in Group C were infused with TXA according to body weight (20 mg/kg) before tourniquet deflation and again 3 h later. Baseline characteristics and data collected at blood transfusion were compared. Differences among four time points (baseline, day 0, day 2, and day 5) were carried out using ANOVA.ResultsThe hemoglobin levels at postoperative day 5 were 10.6 g/dL for Group A, 10.6 g/dL for Group B, and 10.7 g/dL for Group C. The drain output was 399 ml for Group A, 314 ml for Group B, and 305 ml for Group C (p = 0.03). Group C had significantly less drain output than Group A after post hoc comparisons (p = 0.05), whereas no significant difference was observed between Group A and B (p = 0.09) or between Group B and C.ConclusionThe weight-adjusted dose of TXA administered intravenously significantly reduced the drain output but not the total blood loss when compared with the weight-adjusted dose of TXA administered intra-articularly. No significant difference was observed in the other parameters among the three groups.Trial registrationThe Joint CUHK-NTEC CREC, CRE-2013.644-T. Registered 1 March 2014.

Does intraoperative transfusion during total knee arthroplasty reduce the need for transfusion after surgery?: A preliminary retrospective cohort study.

After total knee arthroplasty (TKA), many patients experience anemia due to blood loss. To prevent postoperative anemia and allogeneic blood transfusion after TKA, we used prophylactic allogeneic or autologous blood transfusion intraoperatively. This study evaluated the effects of prophylactic transfusion during TKA. This retrospective cohort study included 579 patients receiving scheduled unilateral TKA. We allocated the patients into three groups, the prophylactic allogeneic transfusion (Group AL), prophylactic autologous transfusion (Group AT), and no prophylactic transfusion with intra-articular tranexamic acid administration (GroupC) groups. After propensity score matching, we compared the rate of postoperative allogeneic blood transfusions until three days after TKA, postoperative hemoglobin and hematocrit levels until four days after TKA, and the side effects in each groups. The postoperative allogeneic blood transfusion rates were statistically higher in group AL and AT than in group C (18.2% and, 18.9% vs 2.3%, respectively; P<0.000). The postoperative hemoglobin and hematocrit levels were statistically lower in group Auto than in group C (P<0.0001), but the levels in group AL were not different from those of group C (P=0.493 vs. P=0.384 respectively). In addition, the side effects were statistically higher in group AL and AT than in group C. Prophylactic intra-operative transfusions did not reduce the rates of allogeneic transfusions and produced more side effects and hypotension after surgery than intra-articular tranexamic acid administration with no prophylactic transfusion in patients undergoing TKAs.

Commentary-LIAT: Local infiltration of analgesia and tranexamic acid is safe and efficacious in reducing blood loss and comparable to intra-articular tranexamic acid in total knee replacements.

Commentary-LIAT: Local infiltration of analgesia and tranexamic acid is safe and efficacious in reducing blood loss and comparable to intra-articular tranexamic acid in total knee replacements.

Effectiveness and Safety of the Combined Use of Tranexamic Acid: A Comparative Observational Study of 1909 Cases.

Tranexamic acid (TA) use in lower‑limb arthroplasty has been valued in these surgeries high‑risk hemorrhagic due to its antifibrinolytic action. The objective of the present study was to determine the effectiveness of the combined intravenous (IV) and intraarticular (IA) administration of TA in lower‑limb arthroplasty. We conduct a prospective observational study between January 1, 2014, and December 31, 2017, including all programmed lower‑limb arthroplasties. Patients were divided into four groups: no TA, 15mg/kg IV TA, 3g IA TA, and 15mg/kg IV and 3g IA. The effect on calculated total blood loss (milliliter of red blood cell [RBC]), hemoglobin, transfusion, and duration of hospitalization was studied after adjustment on age, American Society of Anesthesiologists, surgery, and postoperative curative anticoagulation. Complications related to TA administration were systematically reported. A total of 1909 patients were included - "no TA," n = 184; "IV," n = 1137; "IA," n = 214; and "IV + IA," n = 374. In the IV + IA group, a decrease in blood loss was observed compared to the no TA group (+ 220ml 95% confidence interval [CI] [184; 255] of RBC P < 0.001) and in the IA group (+ 65ml 95% CI [30; 99] of RBC P < 0.001). The length of hospital stay of the IV + IA group was shorter compared to the no TA group (hazard ratio [HR] 0.35, 95% CI [0.29; 0.43], P < 0.001) to the IA group (HR 0.57, 95% CI [0.48; 0.69], P < 0.001) and the IV group (HR 0.45, 95% CI [0.39; 0.50], P < 0.001). One case of deep vein thrombosis occurred in the group without TA. Administration of combined TA appears effective and safe; further studies are needed in order to establish a consensual protocol.

Effect of Intra Articular Tranexamic Acid Use on Post-Operative Blood Loss in Unilateral Primary Total Knee Arthroplasty (TKA)

Effect of Intra Articular Tranexamic Acid Use on Post-Operative Blood Loss in Unilateral Primary Total Knee Arthroplasty (TKA)

OUTCOMES OF MULTIMODAL COCKTAIL VS TRANEXAMIC ACID ON POST OPERATIVE PAIN AND BLOOD LOSS IN TOTAL KNEE REPLACEMENT PATIENTS: A PROSPECTIVE RANDOMIZED STUDY

Background: Osteoarthritis is the most common form of arthritis and a leading cause of disability. Total knee replacement (TKR) is one of the most effective surgical procedures, providing improvement in function and relief of pain for the majority of patients. Intra-articular tranexamic acid [TXA] and multimodal cocktail (mixture of ketorolac, tramadol and bupivacaine) are commonly used drugs which help to reduce postoperative bleeding and pain respectively, improving outcome of surgery.&#x0D; Objective: To compare the postoperative blood loss and pain with or without Intra-articular tranexamic acid and multimodal cocktail respectively in patients undergoing total knee replacement&#x0D; Material and Methods: A total of 96 patients of either gender presenting to Orthopaedics department of Government Medical College, Amritsar, with knee osteoarthritis and planned to undergo total knee replacement were enrolled. Patients were divided into 3 groups. Group A being the control group was not given tranexamic acid [TXA] but only standard drugs for anesthesia. Group B patients were given 3gm intra-articular injection of tranexamic acid. Group C patients were given a multimodal cocktail (mixture of ketorolac, tramadol and bupivacaine. TKR was done and patients were followed-up for 72 hours. Blood loss and pain score after every 24 hours for 72 hours were noted. Intra-articular injections were given just before wound closure.&#x0D; Results: The mean age of patients in control group was 48.92±13.22years, in TXA group was 52.31±14.69 years and in cocktail group was 50.22±9.63years. The male to female ratio was 11:21, 14:18 and 10:22 in three groups respectively. The total blood loss during first 72 hours was 1030.1±177.27ml in control group, 453.7±80.4ml in TXA group while 607.7±122.5ml in cocktail group. The difference was significant in all three groups and also between TXA and cocktail group (p&lt;0.05). The mean postoperative pain score during first 72 hours was 4.4±2.3in control group, 2.4±1.5 in TXA group while 1.8±1.0in cocktail group. The difference was significant in all three groups (p&lt;0.05) but insignificant between TXA and cocktail group (p&gt;0.05).&#x0D; Conclusion: Results showed that intra-articular injection of TXA is beneficial in reducing blood loss and postoperative pain in comparison to control group. While pain was better controlled with the multimodal cocktail compared to TXA group and control group.&#x0D; Keywords: Post-operative blood loss, Intra-articular injection, tranexamic acid, cocktail, total knee replacement