Different Doses of Intravenous Tranexamic Acid in Revision Total Knee Arthroplasty: A Retrospective Study

Abstract

Purpose This article assessed the efficacy and safety of different doses of intravenous tranexamic acid (TXA) in revision total knee arthroplasty (TKA). Methods We retrospectively identified 122 patients in our institution who underwent revision TKA with a history of perioperative intravenous TXA utilization. According to the sum of intravenous TXA documented, all patients were divided into three groups: 1 g intravenous TXA, 2 g intravenous TXA, and equal or greater than 3 g intravenous TXA. The primary outcomes included total blood loss (TBL), hidden blood loss (HBL), transfusion rate, and the incidence of symptomatic venous thromboembolism among the three groups. A correlation analysis was conducted to analyze the correlation between the dose of TXA and the blood loss. Results In total, there was no significance difference in TBL and revised HBL (rHBL) between the first two groups (1 g/dL for intravenous TXA, 2 g/dL for intravenous TXA; p = 0.486; p = 0.525). Equal or greater than 3 g intravenous TXA (≥3 g/dL for intravenous TXA) reached a significant reduction in TBL, rHBL, and length of stay compared with the first two groups (p = 0.01; p = 0.01; p = 0.01). The rate of transfusion between the three groups did not differ significantly (p = 0.21). Due to the limitations in sample size, only one symptomatic venous thromboembolism was reported in the 1 g intravenous TXA group. Conclusion Applying the dose of intravenous TXA equal or greater than 3 g in revision TKA might further reduce the blood loss and shorten the length of stay.

Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis

“…The results suggest that no significant differences were found between the TXA regimens when assessing hemoglobin reduction (3.4 g/dL in the single-dose IV group and 3.6 g/dL in the double-dose IV group), calculated blood loss ( P = 0.90), or transfusion rates (14% in the single-dose IV group and 18% in the double-dose IV group), whereas according to Kang et al [ 34 ] three doses (3 g) of postoperative IV-TXA reduced blood loss and reduced postoperative inflammation and fibrinolytic reactions more than a single dose (1 g) or two doses (2 g) in elderly patients after TKA without increasing the incidence of adverse events [ 34 ]. A similar observation was made in the Chen et al [ 35 ]; a similar view was reported in the study by Chen et al; a recent randomized controlled trial study showed that [ 33 ] the single-dose regimen was non-inferior compared to the two-dose regimen. Therefore, this meta-analysis will answer the question of whether two-dose versus single-dose intravenous TXA is more effective in terms of total blood loss, transfusion rates, postoperative hemoglobin levels and length of hospital stay, deep venous thrombosis (DVT), and pulmonary embolism (PE), without sacrificing safety.…”

Tranexamic acid in total knee arthroplasty

“…According to the National Joint Registry, more than 100,000 knee replacements are performed each year in England, Wales and Northern Ireland. Whilst most studies related to the use of TXA in knee surgery have examined blood loss in patients with osteoarthritis, it has proven to be efficacious in patients with rheumatoid arthritis [6], cancer [7] and in revision surgery [8]. Therefore, it seems reasonable to administer TXA to all patients requiring knee arthroplasty, irrespective of their underlying diagnosis.…”