Tranexamic acid reduces blood loss in total knee arthroplasty: effectiveness and safety

doi:10.3969/j.issn.2095-4344.2015.31.005

Abstract

Abstract:

BACKGROUND: Tranexamic acid is a synthetic anti-fibrinolytic drug, and can effectively control blood loss after total knee arthroplasty through vein.
OBJECTIVE: To evaluate the effectiveness and safety of tranexamic acid in reducing blood loss after primary unilateral total knee arthroplasty.
METHODS: From 2014 to 2015, 100 patients from the Department of Lower Limb, Sichuan Orthopaedic Hospital underwent primary unilateral total knee arthroplasty, and randomly divided into test group which used tranexamic acid and control group which used tranexamic acid, with 50 cases in each group. 1 g tranexamic acid was infused into the vein at 10 minutes before total knee arthroplasty in the test group, but tranexamic acid was not given in the control group.
RESULTS AND CONCLUSION: The amount of total blood loss, postoperative wound drainage in 24 hours, and the amount of blood transfusion were significantly less in the test group than in the control group (P < 0.05). No significant differences in intraoperative blood loss and the number of patients receiving blood transfusion were found between the test and control groups. No significant difference in preoperative hemoglobin levels was detected before surgery, but hemoglobin levels were decreased after surgery between the two groups. Postoperative hemoglobin levels were apparently higher in the test group than in the control group after surgery. At 24 hours after surgery, no significant difference in coagulation was detectable between the two groups. At 6 days, double lower limb vein color Doppler ultrasound examination did not reveal deep vein thrombosis in both groups. These findings verify that treatment with tranexamic acid in the vein before primary unilateral total knee arthroplasty can evidently diminish the amount of perioperative blood loss and blood transfusion, reduce the risk and cost of blood transfusion, which is good for rehabilitation and does not increase the risk of deep vein thrombosis.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tranexamic Acid, Arthroplasty, Replacement, Knee, Venous Thrombosis, Blood Transfusion

CLC Number:

R318

Cao Wan-jun, Zhu Shao-ling, Liu Xian-dong, Tang Cheng-jie, Zheng Jin-wen, Chen Xing-yu, Liu Ying, Xiao Peng. Tranexamic acid reduces blood loss in total knee arthroplasty: effectiveness and safety[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(31): 4944-4948.

Figures/Tables 5

References

[1] Crantford JC, Wood BC, Claiborne JR, et al. Evaluating the safety and efficacy of tranexamic acid administration in pediatric cranial vault reconstruction. J Craniofac Surg. 2015;26(1):104-107.
[2] 中华医学会骨科分会.预防骨科大手术深静脉血栓形成指南(草案)[J].中国矫形外科杂志,2009,17(2):118-119.
[3] Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51(2):224-232.
[4] Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58(3):277-280.
[5] Sarzaeem MM, Razi M, Kazemian G, et al. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty. J Arthroplasty. 2014;29(8):1521-1524.
[6] Ishii Y, Noguchi H, Sato J, et al. Effect of a single injection of tranexamic acid on blood loss after primary hybrid TKA. Knee. 2015;22(3):197-200.
[7] Hourlier H, Reina N, Fennema P. Single dose intravenous tranexamic acid as effective as continuous infusion in primary total knee arthroplasty: a randomised clinical trial. Arch Orthop Trauma Surg. 2015;135(4):465-471.
[8] Samujh C, Falls TD, Wessel R, et al. Decreased blood transfusion following revision total knee arthroplasty using tranexamic acid. J Arthroplasty. 2014;29(9 Suppl):182-185.
[9] Patel JN, Spanyer JM, Smith LS, et al. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty. 2014;29(8):1528-1531.
[10] Lotke PA, Faralli VJ, Orenstein EM, et al. Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am. 1991;73(7): 1037-1040.
[11] Ishida K, Tsumura N, Kitagawa A, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011;35(11):1639-1645.
[12] Royston D. Blood-sparing drugs: aprotinin, tranexamic acid, and epsilon-aminocaproic acid. Int Anesthesiol Clin. 1995;33(1):155-179.
[13] Hiippala ST, Strid LJ, Wennerstrand MI, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg. 1997;84(4): 839-844.
[14] Faraoni D, Rozen L, Willems A, et al. Experimental model of hyperfibrinolysis designed for rotational thromboelastometry in children with congenital heart disease. Blood Coagul Fibrinolysis. 2015;26(3):290-297.
[15] Aoki A, Suezawa T, Yamamoto S, et al. Effect of antifibrinolytic therapy with tranexamic acid on abdominal aortic aneurysm shrinkage after endovascular repair. J Vasc Surg. 2014;59(5):1203-1208.
[16] Gandhi R, Evans HM, Mahomed SR, et al. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis. BMC Res Notes. 2013;6: 184.
[17] Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012;470(9):2605-2612.
[18] MacGillivray RG, Tarabichi SB, Hawari MF, et al. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty. 2011;26(1):24-28.
[19] Orpen NM, Little C, Walker G, et al. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee. 2006;13(2):106-110.
[20] Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90(5):596-599.
[21] Zhang F, Gao Z, Yu J. Clinical comparative studies on effect of tranexamic acid on blood loss associated with total knee arthroplasty. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007;21(12):1302-1304.
[22] Sepah YJ, Umer M, Ahmad T, et al. Use of tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement. J Orthop Surg Res. 2011;6:22.
[23] Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br. 1996;78(3):434-440.
[24] Kelley TC, Tucker KK, Adams MJ, et al. Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty. Transfusion. 2014;54(1):26-30.
[25] Lee SH, Cho KY, Khurana S, et al. Less blood loss under concomitant administration of tranexamic acid and indirect factor Xa inhibitor following total knee arthroplasty: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2013;21(11):2611-2617.
[26] Oremus K, Sostaric S, Trkulja V, et al. Influence of tranexamic acid on postoperative autologous blood retransfusion in primary total hip and knee arthroplasty: a randomized controlled trial. Transfusion. 2014;54(1):31-41.
[27] Caglar GS, Tasci Y, Kayikcioglu F, et al. Intravenous tranexamic acid use in myomectomy: a prospective randomized double-blind placebo controlled study. Eur J Obstet Gynecol Reprod Biol. 2008;137(2):227-231.
[28] Dietrich W, Spannagl M, Boehm J, et al. Tranexamic acid and aprotinin in primary cardiac operations: an analysis of 220 cardiac surgical patients treated with tranexamic acid or aprotinin. Anesth Analg. 2008;107(5):1469-1478.
[29] Wong J, Abrishami A, El Beheiry H, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am. 2010;92(15):2503-2513.
[30] Santos AT, Kalil RA, Bauemann C, et al. A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting. Braz J Med Biol Res. 2006;39(1): 63-69.
[31] Lin PC, Hsu CH, Huang CC, et al. The blood-saving effect of tranexamic acid in minimally invasive total knee replacement: is an additional pre-operative injection effective? J Bone Joint Surg Br. 2012;94(7):932-936.
[32] Camarasa MA, Ollé G, Serra-Prat M, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth. 2006;96(5):576-582.
[33] Charoencholvanich K, Siriwattanasakul P. Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res. 2011;469(10):2874-2880.
[34] Alvarez JC, Santiveri FX, Ramos I, et al. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion. 2008;48(3):519-525.
[35] Ho KM, Ismail H. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care. 2003; 31(5):529-537.
[36] Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty. 2013;28(9):1473-1476.
[37] Tan J, Chen H, Liu Q, et al. A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res. 2013;184(2): 880-887.
[38] Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, et al. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial. J Bone Joint Surg Am. 2014;96(23): 1937-1944.
[39] Zhou XD, Tao LJ, Li J, et al. Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials. Arch Orthop Trauma Surg. 2013;133(7):1017-1027.
[40] Gillette BP, DeSimone LJ, Trousdale RT, et al. Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty. Clin Orthop Relat Res. 2013;471(1):150-154.
[41] Wu Q, Zhang HA, Liu SL, et al. Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials. Eur J Orthop Surg Traumatol. 2015;25(3):525-541.
[42] Zhao-Yu C, Yan G, Wei C, et al. Reduced blood loss after intra-articular tranexamic acid injection during total knee arthroplasty: a meta-analysis of the literature. Knee Surg Sports Traumatol Arthrosc. 2014;22(12):3181-3190.