Tranexamic Acid in a Multimodal Blood Loss Prevention Protocol to Decrease Blood Loss in Revision Total Knee Arthroplasty: A Cohort Study

Abstract

Purpose: To clarify if blood loss and transfusion requirements can be decreased in revision knee surgery through a multimodal blood loss approach with tranexamic acid (TXA)Patients and Methods: A retrospective study was designed in 87 knees (79 patients) that received a knee revision between 2007 and 2013. To avoid heterogeneity in the surgical technique, only revisions with one single implant system were included. A treatment series of 44 knees that received TXA and other techniques in a multimodal blood loss protocol was compared to a control series of 43 knees that received neither TXA nor the rest of the multimodal blood loss protocol. No differences in the complexity of surgeries or case severity were detected.Results: A significant decrease was observed from 58% transfusion rate in the control group to 5% in the treated group. The postoperative haemoglobin drop was also significantly different. Although the use of a blood loss prevention approach including TXA was the most relevant factor in the transfusion risk (OR=15), longer surgical time also associated an increased risk of transfusion (OR=1.15).Conclusion: This study supports the use of a two-dose intravenous TXA under a multimodal blood loss prevention approach in revision knee replacement with significant reduction in the transfusion rate, postoperative blood loss and haemoglobin drop.

Synergistic effects of intravenous and intra‐articular tranexamic acid on reducing hemoglobin loss in revision total knee arthroplasty: a prospective, randomized, controlled study

“…However, few clinical studies have evaluated the safety and effectiveness of TXA for reducing blood loss during the perioperative period in revision TKA. We only identified five retrospective studies and no prospective studies on the use of TXA in revision TKA …”

“…11.0 (NCSS Statistical Software). Based on previous observations in our orthopedic department and data from retrospective studies of TXA in revision TKA, we assumed a hemoglobin difference of 1.0 g/dL and a standard deviation of 1.5 g/dL with an assumed two‐sided α value of 5% and a power of 80%. Therefore, a minimum sample size of 74 patients was required for this study (37 per group).…”

“…Many studies have shown that TXA reduces blood loss and the need for transfusion in primary TKA without increasing thromboembolic events, such as intramuscular venous thrombosis (IVT), deep vein thrombosis (DVT), and pulmonary embolism (PE) . Five retrospective studies have examined the effects of TXA on decreasing both blood loss and the need for transfusion in revision TKA . To the best of our knowledge, however, no prospective, randomized, controlled study has evaluated the effectiveness of TXA in revision TKA.…”

The efficacy and safety of tranexamic acid in revision total knee arthroplasty: a meta-analysis

“…Thromboembolic complications, such as DVT or PE, were reported in three studies [10, 12, 13]. Two included studies reported that revision components were implanted in both the femur and the tibia [10, 11]. The other two studies stated patients were undergoing revision of two components, revision of one component, or an isolated liner exchange.

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Is tranexamic acid effective and safe for patients undergoing revision total hip and knee arthroplasty: a meta-analysisIs

“…In the past decade, TXA has been widely used in patients undergoing primary joint replacement, and the proportion of patients requiring transfusion during the perioperative period has also been significantly reduced [11,12]. Although sufficient studies have confirmed that TXA can effectively reduce the perioperative blood loss and transfusion rate in pTJA, large trials to study the role of TXA in rTJA are still lacking [13][14][15]. To clarify this issue, we conducted a meta-analysis to assess whether TXA could play an active role in rTJA.…”