Intra-operative local plus systemic tranexamic acid significantly decreases post-operative bleeding and the need for allogeneic blood transfusion in total knee arthroplasty
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.
Sepah Y, Umer M, Ahmad T, Nasim F, Chaudhry U, Umar M, et al. Use of tranexamic acid is a costeffective method in preventing blood loss during and after total knee replacement. J Orthop Surg Res. 2011. p. 22.
2.
Ponnusamy K, Kim T, Khanuja H. Perioperative blood transfusions in orthopaedic surgery. J Bone Joint Surg Am. 2014. p. 96–1836.
3.
Frisch N, Wessell N, Charters M, Yu S, Jeffries J, Silverton C. Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty. 2014. p. 189–92.
4.
Stanworth S, Cockburn H, Boralessa H. Contreras M. Which groups of patients are transfused? A study of red cell usage in London and southeast England. Vox Sang. 2002. p. 352–7.
5.
Wells A, Mounter P, Chapman C, Stainsby D, Wallis J. Where does blood go? Prospective observational study of red cell transfusion in north England. Br Med J. 2002. p. 803–4.
6.
Parvizi J, Chaudhry S, Rasouli M, Pulido L, Joshi A, Herman J, et al. Who needs autologous blood donation in joint replacement? J Knee Surg. 2011. p. 25–31.
7.
Juelsgaard P, Larsen U, Sørensen J, Madsen F, Søballe K. Hypotensive epidural anesthesia in total knee replacement without tourniquet: Reduced blood loss and transfusion. Reg Anesth Pain Med. 2001. p. 105–10.
8.
Onodera T, Majima T, Sawaguchi N, Kasahara Y, Ishigaki T, Minami A. Risk of deep venous thrombosis in drain clamping with tranexamic acid and carbazochrome sodium sulfonate hydrate in total knee arthroplasty. J Arthroplasty. 2012. p. 105–8.
9.
Levy O, Martinowitz U, Oran A, Tauber C, Horoszowski H. The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty. A prospective, randomized, multicenter study. J Bone Joint Surg Am. 1999. p. 1580–8.
10.
Gibbons C, Solan M, Ricketts D, Patterson M. Cryotherapy compared with Robert Jones bandage after total knee replacement: A prospective randomized trial. Int Orthop (SICOT). 2001. p. 250–2.
11.
Hiippala S, Strid L, Wennerstrand M, Arvela V, Mantyla S, Ylinen J, et al. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth. 1995. p. 534–7.
12.
Hiippala S, Strid L, Wennerstrand M, Arvela J, V, Niemelä H, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg. 1997. p. 839–44.
13.
Oremus K. Tranexamic acid for the reduction of blood loss in total knee arthroplasty. Ann Transl Med. 2015. p. 1–4.
14.
Mannucci P. Hemostatic drugs. N Engl J Med. 1998. p. 245–53.
15.
Wang D, Wang H, Cao C, Li L, Meng W, Pei F, et al. Tranexamic acid in primary total knee arthroplasty without tourniquet: a randomized, controlled trial of oral versus intravenous versus topical administration. Sci Rep. 2018. p. 1–9.
16.
Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason J. Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br. 2011. p. 1577–85.
17.
Yuan X, Wang J, Wang Q, Zhang X. Synergistic effects of intravenous and intra-articular tranexamic acid on reducing hemoglobin loss in revision total knee arthroplasty: a prospective, randomized, controlled study. Transfusion. 2018. p. 982–8.
18.
Kumar N, Saleh J, Gardiner E, Devadoss V, Howell F. Plugging the intramedullary canal of the femur in total knee arthroplasty: Reduction in postoperative blood loss. J Arthroplasty. 2000. p. 947–9.
19.
Cerciello S, Robin J, Lustig S, Maccauro G, Heyse T, Neyret P. The role of patelloplasty in total knee arthroplasty. Arch Orthop Trauma Surg. 2016. p. 1607–13.
20.
Brodell J, Axon D, Evarts C. The Robert Jones bandage. J Bone Joint Surg Br. 1986. p. 776–9.
21.
Wong J, Abrishami A, Beheiry E, Mahomed H, Davey N, Gandhi J, 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. p. 2503–13.
22.
Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop (SICOT). 2011. p. 1639–45.
23.
Seo J, Moon Y, Park S, Kim S, Ko K. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surgery Sport Traumatol Arthrosc. 2013. p. 1869–74.
24.
Nielsen C, Jans Ø, Ørsnes T, Foss N, Troelsen A, Husted H. Combined intra-articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2016. p. 835–41.
25.
Zhang Y, Yang B, Sun X, Zhang Z, Figueiredo N. Combined intravenous and intra-articular tranexamic acid administration in total knee arthroplasty for preventing blood loss and hyperfibrinolysis: A randomized controlled trial. Med (United States). 2019. p. 1–8.
26.
Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2012. p. 1153–9.
27.
Zhang H, Chen J, Chen F, Que W. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: A meta-analysis. Knee Surgery Sport Traumatol Arthrosc. 2012. p. 1742–52.
28.
Panteli M, Papakostidis C, Dahabreh Z, Giannoudis P. Topical tranexamic acid in total knee replacement: A systematic review and meta-analysis. Knee. 2013. p. 300–9.
29.
Tan J, Chen H, Liu Q, Chen C, Huang W. A metaanalysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res. 2013. p. 880–7.
30.
Yuan Z, Yin H, Ma W, Xing D. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: combined tranexamic acid for TKA. Bone Joint Res. 2016. p. 353–61.
31.
Fillingham Y, Ramkumar D, Jevsevar D, Yates A, Shores P, Mullen K, et al. The efficacy of tranexamic acid in total knee arthroplasty: a network metaanalysis. J Arthroplasty. 2018. p. 3090–8.
32.
Xu S, Chen J, Zheng Q, Lo N, Chia S, Tay K, et al. The safest and most efficacious route of tranexamic acid administration in total joint arthroplasty: A systemic review and network meta-analysis. Thromb Res. 2019. p. 61–6.
33.
Sun Q Li J, Chen J, Zheng C, Liu C, Jia Y. Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: A meta-analysis of randomised controlled trials. BMJ Open. 2019. p. 1–14.
34.
Moskal J, Capps S. Intra-articular tranexamic acid in primary total knee arthroplasty: meta-analysis. J Knee Surg. 2018. p. 56–67.
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