Effect of Tranexamic Acid on Bleeding Control in Total Knee Arthroplasty

Abstract

Objectives: To analyze the effectiveness of intravenous (IV) tranexamic acid (TA) in reducing blood loss in total knee arthroplasty (TKA).Method: The population sample was composed of patients with a diagnosis of primary knee osteoarthritis. The patients undergoing TKA were divided in two groups. Group A: comprised patients who used IV TA and B group, formed by patients who did not use TA in the intra or post-operative period. For descriptive analysis, quantitative variables were represented by mean and standard deviations when their distribution was normal and interquartile ranges and medians for non-normal variables.Results: The mean age of patients was 68 years old, most of them were female and with involvement of the left knee. Postoperatively patients who had used IV TA showed less bleeding rate and less hemoglobin rate reduction.Conclusion: The use of IV TA in TKA reduces blood loss in peri- and postoperative periods. Regarding total blood loss reduction, hemoglobin rate and need for blood transfusions, IV TA should be used routinely during TKA since it has been shown to be safe with no increase in side effects as thromboembolic events. Level of Evidence III. Retrospective Comparative Study.

Efficacy of Tranexamic Acid in Reducing Blood Loss in Total Knee Arthroplasty

“…Patient follow-up in the studies evaluated was also short, and new RCTs with longer follow-up are necessary; these should investigate the occult bleeding rate, as well as the occurrence of late complications such as deep venous thrombosis (DVT) and pulmonary embolism (PE). 19 …”

Evaluation of the use of tranexamic acid in total knee arthroplasty

“…Intravenous administration of tranexamic acid has the advantage of being faster; it is not necessary to await the effect of the medication, a characteristic of the topical method. 13 Similarly, the literature is not clear regarding the effects of tranexamic acid applied topically in contact with bone or muscle tissue 13 ; Furthermore, there is no consensus on the concentration in the topical application. 27 Therefore, the authors opted to assess only the intravenous administration of this drug associated with a control group.…”

“…The fact that blood transfusion was required in six patients in the control group and in none of the patients in the intervention group demonstrates a lower tendency for transfusion in the cases that used tranexamic acid, which is consistent with the expected result of the use of this drug. 13 …”

“…In order to reduce the number of blood transfusions in TKA, some precautions are taken to try to minimize perioperative and postoperative bleeding, such as occlusion of the femoral intramedullary canal with bone graft, 8 use of pneumatic tourniquet and suction drain, 3 , 4 improvement of surgical technique, 3 anesthesia combined with hypotension, 9 cryotherapy and Jones bandage, 10 postoperative drainage clamping, 11 local application of fibrin glue, 12 use of tranexamic acid, 13 local infusion with norepinephrine, 14 and the placement of platelet gel in the operative wound. 15 …”

The use of tranexamic acid in patients submitted to primary total hip arthroplasty: an evaluation of its impact in different administration protocols

“…Approximately 90% of an IV dose is excreted in the urine within 24 h; the plasma half-life is of approximately 2 h, and the therapeutic levels are maintained for 6–8 h. Its action preserves the clot and makes the hemostatic mechanism more efficient, reducing the intensity and risk of bleeding; it can be administered intravenously or topically. 8 …”