A study of efficacy of tranexamic acid in reduction of blood loss in primary total knee arthroplasty
Keywords:Tranexamic acid, Total knee replacement, Blood transfusion
Background: Tranexamic acid (TXA) has been shown to be effective in reducing blood loss during trauma and surgeries. Although there is no well-established protocol, it is now increasingly being used in joint replacement surgeries. The present study was designed to study the effect of intravenously given tranexamic acid during primary total knee replacement in reducing intraoperative blood loss and need for blood transfusion requirement, compared to a placebo.
Methods: This study was designed as a parallel arm, double blind trial. 100 patients of primary osteoarthritis undergoing total knee arthroplasty under tourniquet was included in the study. The efficacy of a single preoperative bolus of TXA in the dose of 15 mg/kg on perioperative blood losses was studied against a placebo with objectives to compare the pre- and 24-hours post-operative level of haemoglobin (Hb) and haematocrit (Hct) levels and assess total volume of blood loss till 24-hours postoperatively and need for blood transfusion.
Results: Out of 168 patients, who underwent TKA in our centre during the period of the study, 100 were included in the study, 50 patients were included in placebo group and 50 patients were included in TXA group. There was a statistically significant reduction in the use of transfusion (Fisher exact test; P=0.001). A total of 46 units of blood were used; 42 units transfused to participants in the placebo group and only 4 units transfused to participants in the TXA group.
Conclusions: Intravenous TXA in primary arthroplasty leads to a statistically significant reduction in total blood loss and requirement for allogeneic blood transfusion with no apparent increased risk of thrombo-embolic complications.
Molloy DO, Archbold HAP, Ogonda L, McConway J, Wilson RK, Beverland DE. Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial. J Bone Joint Surg Br. 2007;89(3):306–9.
Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90(5):596–9.
Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemelä HM, Mäntylä SK, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg. 1997;84(4):839–44.
Sehat, Evans, Newman. How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee. 2000;7(3):151–5.
Kleinman S, Chan P, Robillard P. Risks associated with transfusion of cellular blood components in Canada. Transfus Med Rev. 2003;17(2):120–62.
Vamvakas EC, Taswell HF. Epidemiology of blood transfusion. Transfusion. 1994;34(6):464–70.
Kakar PN, Gupta N, Govil P, Shah V. Efficacy and Safety of Tranexamic Acid in Control of Bleeding Following TKR: A Randomized Clinical Trial. Indian J Anaesth. 2009;53(6):667–71.
Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am. 2010;92(15):2503–13.
Orpen NM, Little C, Walker G, Crawfurd EJP. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee. 2006;13(2):106–10.
Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, et al. CRASH-2 Trial Collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo controlled trial. Lancet. 2010;376(9734):23-32.
Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147(2):113-9.
Eipe N, Ponniah M. Perioperative blood loss assessment-How accurate? Indian J Anaesthesia. 2006;50(1):35.
Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58:277–280.
Nielsen RET, Husted H. Tranexamic acid reduces blood loss and the need of blood transfusion after knee arthroplasty. Ugeskr Laeg. 2002;164(3):326–9.
Thorsson O, Leander P, Lilja B, Nilsson P, Obrant KJ, Westlin N. Comparing ultrasonography, magnetic resonance imaging and scintigraphy in evaluating an experimentally induced muscular hematoma. Scandinavian J Med Sci In Sports. 1993;3(2):110–6.