2019, Vol. 3 Issue 4, Part A
TKA has been considered one of the most successful surgeries in orthopedics. Blood loss related to total knee arthroplasty has been a topic of concern. Post operative blood transfusion carries imminent risk of disease transmission, febrile reactions and involves additional cost. It is advisable to avoid blood transfusion in the postoperative cases whenever possible. Many strategies are used to reduce postoperative blood loss like intraoperative tourniquet, cell savers and preoperative hemoglobin raising agents. Drugs like Tranexamic acid (TA) that inhibit the fibrinolytic system may be used to reduce the intraoperative and postoperative blood loss. Inhibition of fibrinolysis may increase the chances of thromboembolic disease. We studied the efficacy of parenteral tranexamic acid (TA) in reducing the postoperative blood loss and blood transfusion requirements and its impact on incidence of DVT in the postoperative period after TKA.
Patients and Methods: We did a prospective, randomised, double blind study on 130 patients who underwent primary unilateral cemented total knee arthroplasty between May 2016 and May 2017 at our institution. Patients were randomized into two groups: the study group received tranexamic acid intravenously (15 mg/kg) 10 minutes before inflation of the tourniquet and 3 hours postoperatively while the control group received a similar volume of normal saline (placebo) at similar timings. We measured the reduction in hemoglobin levels at 24 hours postoperatively, total volume of blood drained at 24 hours postoperatively, amount of blood transfused, and number of patients requiring allogenic blood transfusion in the initial two days of surgery. All patients were screened for DVT with duplex ultrasound assessment of both legs on the third post-operative day. The minimum follow up was 6 months (mean, 10.4 months; range, 6–12 months).
Results: We found a statistically significant (p<0.05) decrease in blood loss in the early post-operative period study group receiving parenteral transexamic acid as compared to the control group. The mean reduction of hemoglobin at 24 hours postoperatively was lower in patients receiving IV tranexamic acid (1.86 ± 0.04 g/dL) than in control subjects (3.03 ± 0.18 g/dL). The mean amount of blood drained in the postoperative period in the study group (628 ± 226 mL) was lower than the control group (1086 ± 362 mL).The number of patients requiring blood transfusion were lower in the study group than control group. There was no of evidence in DVT in either group on duplex ultrasound screening of the lower limbs in the early postoperative period.
Conclusions: Intravenous Tranexamic acid is a safe, efficacious and cost effective strategy to reduce the perioperative blood loss and transfusion in total knee athroplasty patients. There was no associated increase of thromboembolic complications in our review.