A Prospective Study on Role of Tranexamic Acid in Reducing Postoperative Blood Loss in Total Knee Arthroplasty and Its Effect on Coagulation Profile

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Abstract

Total knee arthroplasty(TKA) is associated with extensive postoperative blood loss. Despite various studies proving the efficacy of Tranexamic Acid (TEA) with single or multiple boluses of different sizes with or without subsequent infusions, no consensus has been reached on the dose of tranexamic acid to be administered or the duration of treatment. In this study, we have investigated in a homogenous healthy population undergoing total knee arthroplasty, if administration of a high dose of tranexamic acid has a blood sparing effect. They were found to be significant with high power concluding a decrease in total blood loss in patients who were administered Tranexamic Acid (TEA) during Total Knee Arthroplasty (TKA). A dose regimen of 15 mg/kg every 8 h for 24 h would seem appropriate as longer administration of TEA was not accompanied by further reduction in blood loss.

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Material and Methods

The present study was a case control study started from December 2007 to August 2011. We studied all the patients (60 patients) with primary osteoarthritis of both knees undergoing staged bilateral TKA at an interval of 3 weeks who had been administered TEA as per our protocol in their first knee arthroplasty and they were as control in their second knee arthroplasty. Patients with a proven history of thromboembolic disease, cerebrovascular disease, recent myocardial infarction or unstable

Results

The study of 60 cases of bilateral staged TKA had the same patients as cases as well as controls so the study automatically statistically matched.

Mean age of the patients undergoing TKA was 61.5 years with male to female ratio of 7:5. Duration of surgery was 100 min (86–120) for the control group as compared to 91 (81 112) min for the TEA group.

Tourniquet time was 91 min (82–102) for the control group, 80 min (72–92) for the TEA group.

The mean preoperative Hb and preoperative and postoperative Hct

Discussion

The fact that the study was automatically well matched and all the patients in both groups were operated on by the same senior surgeon excluded the possibility of surgeon dependent factors affecting the results and further added strength to our study Various antifibrinolytic agents such as, aprotinin, e-aminocaproic acid and TEA can help reduce blood loss in TKA. Of these TEA is preferred as it is cheaper and less allergenic than aprotinin and is more potent than e-aminocaproic acid. We have

Summary

So we conclude that a dose of 15 mg/kg every 8 h for 24 h would seem appropriate as longer administration of TEA is not accompanied by further reduction in blood loss.

Conflict of Interest Statements

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The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.09.002.

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