The effect of single high dose preoperative intravenous tranexamic acid administration to reduce blood loss in patients with primary total knee replacement

Abstract

K nee replacement surgery is one of the most common procedures for knee osteoarthritis. This procedure can lead to significant blood loss, and the blood transfusion rate is high. In 34% of patients who underwent total knee replacement (TKR), perioperative blood transfusions are being performed at least once. [1] Allogeneic blood transfusion is associated with a variety of risks such as transfusion reaction, volume overload of the heart, and inhibition of immune system. [2-4] Blood transfusion increases hospitalization cost. [5] In clinical practice, different protective measures such as autologous blood transfusion have been used to reduce postoperative blood transfusion rates. [6-8] Other methods for prevention of perioperative blood loss include preoperative administration of erythropoietin, preoperative administration of iron supplements, normovolemic hemodilution, controlled hypotension, tourniquet use, and application of antifibrinolytic agents. [9-12] Tranexamic acid (TA) is a lysine analog that blocks plas-Objectives: This study aimed to analyze the efficacy of single-dose tranexamic acid (TA) 20 mg/kg preoperatively to reduce blood loss in patients undergoing total knee replacement (TKR). Methods: A total of 387 patients (82 males, 305 females) undergoing TKR between January 2014 and December 2018 were included in the study. The T + group was administrated intravenous (iv) TA 20 mg/kg 20 min before the skin incision. We determined perioperative blood loss, the amount of drainage postoperative 24 h, the amount of drainage after postoperative 24-48 h, total volume of drains, total volume of blood loss, postoperative hemoglobin and hematocrit levels, and amount of total blood transfusion. Results: In terms of demographic data, no statistically significant difference was observed between the groups. Perioperative blood loss and total volume of blood loss was found statistically higher in T − group compared to T + group. Postoperatively, the mean hemoglobin and hematocrit levels of T − group were statistically significantly lower than T + group. Conclusion: A single 20 mg/kg iv TA administration before TKR reduces bleeding during surgery and within 24 h postoperatively.

The Effect of Local Tranexamic Acid Administration on Blood Loss and Transfusion in Total Knee Arthroplasty: A Retrospective Study

“…In several studies, tranexamic acid has been used locally, systemically, or in combination to decrease blood loss and the need for transfusions after TKA. [ 9 , 10 ] Local administration of tranexamic acid is as effective as systemic and combined approaches. However, there is no consensus on the route of administration, dose and when it should be administered.…”

“…However, there is no consensus on the route of administration, dose and when it should be administered. [ 9 , 11 ] Concerns about tranexamic acid’s possible connection to thromboembolic events arise from how it is administered. Recent research, however, has failed to demonstrate a relationship between these events and the route of administration.…”

Long-term effects of metal-on-metal Cobalt-Chromium-containing prostheses used in total knee arthroplasty on hearing and tinnitus

“…Knee replacement surgery is one of the most common procedures for knee osteoarthritis. [ 17 ] Since the mid-1990s, Co-chromium-containing MoM prostheses have been widely used in arthroplasty. In the following years, increases in Co and Cr metal ions were observed, mostly due to wear caused by malpositioned components.…”