Blood-conserving efficacy of multiple doses of oral tranexamic acid associated with an enhanced-recovery programme in primary total knee arthroplasty: a randomized controlled trial

Abstract

The addition of two or three postoperative doses of TXA to one preoperative dose produced a significant reduction in blood loss. The two-dose postoperative regimen is the least necessary regimen for clinical efficacy in primary unilateral TKA. The three-dose regimen produced maximum reduction of blood loss. Cite this article: Bone Joint J 2018;100-B:1025-32.

The antifibrinolytic and anti‐inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial

“…Thus, maintaining such inhibited fibrinolytic activity in the postoperative period may cover the period of high fibrinolysis and lead to the maximum reduction in blood loss. Our RCT demonstrated that multiple doses of intravenous or oral TXA were superior to a single bolus in stopping bleeding in TKA patients . However, no pharmacokinetic and serum analyses or concomitant coagulation monitoring were performed in these and many other studies, and the changes in coagulation and systemic absorption of TXA after such administration remain unclear.…”

“…According to our pharmacokinetic analysis, the administration of 2 g of oral TXA 2 h preoperatively can result in a therapeutic level by the beginning of the operation. The maintenance dose of oral TXA applied in this study was based on studies of this drug in total joint arthroplasty, in which maintenance doses range from 1 g to 2 g, delivered over a period of 1–18 h . The findings from studies of the effects of maintenance doses of TXA on blood loss have indicated that there is no significant difference between low and high doses .…”

“…It was used beginning (2000 AxaIU; Clexane [enoxaparin sodium], administered subcutaneously) 8 h postoperatively, and was continued once daily (4000 IU) during hospitalization. Rivaroxaban (10 mg, administered orally; Bayer, Leverkusen, Germany) was continued for 10 days after discharge .…”

“…Categorical variables are presented as counts. One‐way anova with a post hoc Tukey's test was used to compare normally distributed continuous variables, and the Kruskal–Wallis with a post hoc Nemenyi test was applied to compare skewed continuous variables . Moreover, repeated measurement regression with random intercepts and first‐order autocorrelation was used to test continuous data with repeated measures.…”

“…Thus, it may be beneficial to prolong antifibrinolytic and anti‐inflammatory treatment during the postoperative period . Additionally, it has been shown that multiple boluses of intravenous or oral TXA can effectively reduce bleeding and inflammatory responses in TKA patients . However, the TXA dosage regimens in these and many other studies were not based on pharmacokinetic modeling .…”