Decreased blood loss with systemic and intraarticular tranexamic acid administration after total knee arthroplasty

Year 2020, Volume: 12 Issue: 1, 12 - 18, 02.03.2020

Zekeriya Okan Karaduman

https://doi.org/10.18521/ktd.650164

Cited By: 1

Abstract

Objective:
Perioperative bleeding during
total knee arthroplasty (TKA) is a lasting problem for surgeons. Intravenous or
intra-articular administration of tranexamic acid (TXA) can effectively stop
bleeding, but there is still no uniform standard for the best administration
and dosing.

Method: Between October 2017 and September 2019, ninety patients with unilateral
primary knee osteoarthritis requiring knee replacement were retrospectively
evaluated and investigated in three groups according to the route of TXA administration:
Group 1 (n=30) intravenous (IV) injection, Group 2 (n=30) intra-articular
injection (IAI), and Group 3 (n = 30) combined IV and IAI. Demographic characteristics,
hematological indices, and the incidence of deep vein thrombosis (DVT) and
pulmonary embolism (PE) were studied.

Results: Of the patients included in the study, 86%
were female (n=78), and 14% were male (n=12). The gender distribution of the
groups was homogeneous (p=0.749). The mean hemoglobin values of Group 2 were significantly lower
than those of Group 1 and Group 3 (p=0.002 and p=0.045, respectively). Less
postoperative blood loss was observed in the group receiving combined IV and IA
TXA. The mean blood loss from the drain in Group 3 was significantly lower than
that in Group 1 and Group 2 (p=0.001). Postoperative infection, DVT, and PE
were not seen in any group.

Conclusion: This study demonstrated that the use of
intraarticular and intravenous tranexamic acid in primary unilateral TKA
significantly reduced postoperative blood loss and consequently decreased the
need for blood transfusion without an increase in adverse events, particularly
thromboembolic complications.

Keywords

Total knee arthroplasty, Tranexamic acid, Efficacy, Bleeding

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