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Review paper
Received: 02.12.2020. >> Accepted: 11.12.2020. >> Published: 09.10.2020. Biochemistry
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https://doi.org/10.17392/1327-21

Intra-operative local plus systemic tranexamic acid significantly decreases post-operative bleeding and the need for allogeneic blood transfusion in total knee arthroplasty

By
Lidia De Falco Orcid logo ,
Lidia De Falco
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Section of Orthopaedics and Traumatology, Department of Medicine Surgery and Neurosciences, University of Siena , Siena , Italy

Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Senese , Siena , Italy

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Elisa Troiano ,
Elisa Troiano
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Martina Cesari ,
Martina Cesari

Section of Orthopaedics and Traumatology, Department of Medicine Surgery and Neurosciences, University of Siena , Siena , Italy

Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Senese , Siena , Italy

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Pietro Aiuto ,
Pietro Aiuto

Section of Orthopaedics and Traumatology, Department of Medicine Surgery and Neurosciences, University of Siena , Siena , Italy

Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Senese , Siena , Italy

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Giacomo Peri ,
Giacomo Peri

Section of Orthopaedics and Traumatology, Department of Medicine Surgery and Neurosciences, University of Siena , Siena , Italy

Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Senese , Siena , Italy

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Nicolò Nuvoli ,
Nicolò Nuvoli

Section of Orthopaedics and Traumatology, Department of Medicine Surgery and Neurosciences, University of Siena , Siena , Italy

Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Senese , Siena , Italy

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Mattia Fortina ,
Mattia Fortina

Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Senese , Siena , Italy

Section of Orthopaedics and Traumatology, Department of Medicine Surgery and Neurosciences, University of Siena , Siena , Italy

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Nicola Mondanelli ,
Nicola Mondanelli
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Section of Orthopaedics and Traumatology, Department of Medicine Surgery and Neurosciences, University of Siena , Siena , Italy

Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Senese , Siena , Italy

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Stefano Giannotti
Stefano Giannotti

Section of Orthopaedics and Traumatology, Department of Medicine Surgery and Neurosciences, University of Siena , Siena , Italy

Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Senese , Siena , Italy

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Abstract

Aim
 To evaluate the efficacy of systemic plus local tranexamic acid (TXA) in reducing post-operative bleeding, haemoglobin loss and the need for allogeneic blood transfusion (ABT) in total knee arthroplasty (TKA).
Methods
All patients undergoing TKA between January 2017 and September 2019 were retrospectively evaluated. Exclusion criteria were cardiovascular comorbidities, diabetes and the assumption of any anticoagulant/antiaggregant therapy in the pre-operative period. All patients received the same prosthesis with the same surgical technique and were operated on by the same surgeon. Twenty patients were found (group A) that received intra-operative TXA (20 mg/kg intravenous 10 minutes before deflating tourniquet and 1g intra-articular after capsular suture). A control group of 26 patients not receiving TXA was matched for demographics (group B).
Results
Two (10%) patients in group A and 16 (61.5%) in group B needed ABT in the post-operative period (p=0.0004). Each patient in group A received 2 red blood cells (RBCs) units, while in group B 2 patients received one RBCs unit and one patient 4 RBCs units, for a total of 4 and 32 RBCs units in group A and B, respectively (p=0.0006). The minimum haemoglobin level was observed at 48 hours post-operatively in both groups: mean decrease was 3.54 and 4.64 g/dL in group A and B, respectively (p=0.0126).
Conclusion
The association of systemic and local TXA administration seems to significantly reduce post-operative bleeding and
the need for RBCs transfusions after TKA in patients not assuming any anticoagulant / antiaggregant therapy and without cardiovascular and diabetic morbidities.

Keywords:

bleeding,
haemoglobin,
orthopaedic surgery,
postoperative anaemia,
red blood cells

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