Intravenous and intraarticular tranexamic acid can reduce blood loss and inflammatory response during cemented posterior cruciate ligament-retaining unilateral total knee arthroplasty

doi:10.3969/j.issn.2095-4344.1962

Abstract

Abstract:

BACKGROUND: A large number of literatures have confirmed that the use of tranexamic acid in total knee arthroplasty can effectively reduce perioperative bleeding, but there is no consensus on which tranexamic acid is most used. Little is reported on the changes of related inflammatory factors in blood after tranexamic acid is given.

OBJECTIVE: To investigate the effects of different tranexamic acid administration methods on perioperative blood loss and inflammatory response in total knee arthroplasty.

METHODS: Ninety patients who underwent unilateral total knee arthroplasty due to knee osteoarthritis from June 2016 to June 2018 were included in this study. They were randomly divided into three groups, 30 in each group using the envelope lottery method. All of them received cemented posterior cruciate ligament-retaining unilateral total knee arthroplasty. In group A, patients were treated by intravenous infusion of tranexamic acid. In group B, intraarticular injection of tranexamic acid was performed. In group C, both intravenous and intraarticular administration of tranexamic acid was used. Perioperative total blood loss and occult blood loss were calculated, and the number of patients receiving blood transfusion and the volume of blood transfused were recorded. Fibrinogen level, prothrombin time, activated partial thromboplastin time, and the levels of inflammatory factors C-reactive protein and interleukin-6 were measured before and 1, 3 and 7 days after surgery. Deep vein thrombosis was examined at 1 week after surgery. All patients were followed up for 6 months to determine the occurrence of deep vein thrombosis and pulmonary embolism. This study was approved by the Medical Ethics Committee of the Third People’s Hospital of Hainan Province, China.

RESULTS AND CONCLUSION: (1) Total perioperative blood loss in groups A and B was significantly higher than that in group C (P < 0.05). There were no significant differences in occult blood loss and blood transfusion rate among the three groups (P > 0.05). (2) There were no significant differences in fibrinogen level, prothrombin time and activated partial thromboplastin time among three groups before surgery and at 1, 3 and 7 days after surgery (P > 0.05). (3) In each group, C-reactive protein and interleukin-6 levels at 1 and 3 days after surgery were significantly higher than those before surgery (P < 0.05), and there were no significant differences in C-reactive protein and interleukin-6 levels among three groups (P > 0.05). (4) At 7 days after surgery, the levels of C-reactive protein and interleukin-6 in each group decreased to the levels before surgery, and there were no significant differences among three groups (P > 0.05). Vascular ultrasound examination of the both lower limbs showed no deep vein thrombosis at 1 week after surgery. After 6 months of follow-up, there were no cases of deep venous thrombosis and pulmonary embolism in the lower limbs. (5) The results suggest that compared with simple intravenous or intraarticular administration of tranexamic acid, combined intravenous and intraarticular administration of tranexamic acid can greatly reduce total perioperative blood loss and does not increase the risk of developing deep vein thrombosis after total knee arthroplasty. Different administration methods of tranexamic acid have no obvious effects on inflammatory response.

Key words: total knee arthroplasty, tranexamic acid, intraarticular injection, intravenous injection, amount of blood loss, C-reactive protein, interleukin-6, deep vein thrombosis

CLC Number:

R618|R453.9|R318

Wu Xingyuan, Zhang Guoru, Liu Tang, Zhou Caisheng. Intravenous and intraarticular tranexamic acid can reduce blood loss and inflammatory response during cemented posterior cruciate ligament-retaining unilateral total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(36): 5753-5759.

Figures/Tables 4

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