Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial

Abstract

BackgroundRecently, a number of studies using intra-articular application of tranexamic acid (IA-TXA), with different dosage and techniques, successfully reduced postoperative blood loss in total knee replacement (TKR). However, best of our knowledge, the very low dose of IA-TXA with drain clamping technique in conventional TKR has not been yet studied. This study aimed to evaluate the effectiveness and dose-response effect of two low-dose IA-TXA regimens in conventional TKR on blood loss and blood transfusion reduction.MethodsBetween 2010 and 2011, a triple-blinded randomized controlled study was conducted in 135 patients undergoing conventional TKR. The patients were allocated into three groups according to intra-articular solution received: Control group (physiologic saline), TXA-250 group (TXA 250 mg), and TXA-500 group (TXA 500 mg). The solution was injected after wound closure followed by drain clamping for 2 hours. Blood loss and transfusion were recorded. Duplex ultrasound was performed. Functional outcome and complication were followed for one year.ResultsThere were forty-five patients per groups. The mean total hemoglobin loss was 2.9 g/dL in control group compared with 2.2 g/dL in both TXA groups (p > 0.001). Ten patients (22%, control), six patients (13%, TXA-250) and none (TXA-500) required transfusion (p = 0.005). Thromboembolic events were detected in 7 patients (4 controls, 1 TXA-250, and 2 TXA-500). Functional outcome was non-significant difference between groups.ConclusionsCombined low-dose IA-TXA, as 500 mg, with 2-hour clamp drain is effective for reducing postoperative blood loss and transfusion in conventional TKR without significant difference in postoperative knee function or complication.Trial registrationClinicalTrials.gov NCT01850394.

One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration

“…Out of the 31 studies (Table 2), two were triple-blind [22,23], 20 were double-blind [8,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], three were single-blind [43][44][45], one study was non-blinded [46], and the blinding was unclear in five of the studies [47][48][49][50][51]. In one study, the randomization was performed by a person/ pharmacist/resident who was not involved in the study or the care of patients [35].…”

“…It is worthwhile mentioning that the dose of IA TXA and tissue contact time should be noted. As postulated by Sa-ngasoongsong and colleagues [23], the prolonged contact time with the tissue could enhance the effect of low-dose TXA due to using the clamping drain technique, resulting in more efficacy in controlling postoperative blood loss and reducing the need for blood transfusions.…”

Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty: Meta-analysis

“…The remaining 41 articles are included in this article as either background or supportive material (n ¼ 25) 2, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][25][26][27][28][29][30][31] or as the quantitative meta-analysis (n ¼ 16). 1,3,23,24,[32][33][34][35][36][37][38][39][40][41][42][43] The study selection is shown in the PRISMA flowchart (►Fig. 1).…”

“…Eight of the 16 studies included in the meta-analysis were blinded randomized controlled trials, CEBM Level I, 32,34,36,[38][39][40]42,43 1 study was a nonblinded randomized controlled trial, CEBM Level II, 41 and the remaining 7 studies were case-controlled trials, CEBM Level III 1,3,23,24,33,35,37 (►Table 1). Sample sizes ranged from 24 to 373 patients receiving unilateral TKAs, a total of 2,610 patients (1,339 IA-TXA and 1,271 placebo) were enrolled in the 16 studies.…”

Is Continuous Locking Suture with Braided Suture Sufficient for Arthrotomy Repair in the Conventional TKR? A Randomized Controlled Trial Study

“…The skin was closed with the interrupted vertical mattress suture using 3 − 0 Ethilon® (Ethicon, Cincinnati, OH, USA). After wound closure, the intra-articular tranexamic application was applied through the drain tube, and the drain was clamped for 2 hours, as described by Sa-ngasoongsong et al [18].…”