Intravenous tranexamic acid in total knee arthroplasty without tourniquet
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Published:
Oct 6, 2014
Keywords:
Tranexamic acid. Total knee arthroplasty. Tourniquet.
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Abstract
Background: Total knee arthroplasty is associated with peri- and postoperative blood loss (600 to 1500 mL) and with blood transfusion rates of up to 50%. The objective is to study the effect of tranexamic acid in total knee arthroplasty without tourniquet, taking into account the blood loss in the postoperative period.Method: Patients were randomized into two groups: Group A, with tranexamic acid, 25 patients (71.5 years old) and Group B, without tranexamic acid, 25 patients (72 years old). Hemoglobin and hematocrit were evaluated prior to surgery and after 24, 48 and 72 hours. Drain- age was evaluated after 24 hours.Results: The postoperative hematocrit after 24, 48 and 72 hours was 33.4%, 31.5% and 30.8%, respectively, in Group A, and 28.5%, 27.9% and 27%, respectively, in Group B (p <0.001 in the 3 registers). Hemoglobin values were 11, 10.3 and 10 g/dL, respectively, in Group A and 9.4, 9.3 and 9 g/dL, in Group B (p <0.001, p = 0.004 and p = 0.002). Drainage after 24 hours in Group A was 363.4 mL (± 141 mL) and 626 mL (± 260 mL) in Group B (p <0.001). Thirty two patients in Group B underwent transfusion, while none in group A. No cases of thromboembolic disease were detected.Conclusion: Tranexamic acid use decreases postoperative bleeding associated with total knee arthroplasty, resulting in lower transfusion rates without an increase in complication risks.
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Bidolegui, F. M., Pereira, S. P., Lugones, A., & Vindver, G. I. (2014). Intravenous tranexamic acid in total knee arthroplasty without tourniquet. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 79(3), 154-162. https://doi.org/10.15417/242
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Clinical Research
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References
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2. Goodnough LT, Verbrugge D, Marcus RE. The relationship between hematocrit, blood lost and blood transfused in total knee
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knee arthroplasty. Clin Orthop Relat Res 1994;(299):147-52.
5. Lemaire R. Strategy for blood management in orthopedics and trauma surgery. J Bone Joint Surg Br 2008;90(9):1128-36.
6. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM. Tranexamic acid in total knee replacement: a systematic
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7. Benoni G, Bjorkman S, Fredin H. Application of pharmakinetic data from healthy volunteers for the prediction of plasma
concentrations of tranexamic acid in surgical patients. Clin Drug Invest 1995;10(5):280-7.
8. Camarasa MA, Olle G, Serra-Prat M, Martín A, Sánchez M, Ricós P, et al. Efficacy of aminocaproic, tranexamic acids in the
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9. Longstaff C. Studies on the mechanisms of action of aprotinin and tranexamic acid as plasmin inhibitors and antifibrinolytic
agents. Blood Coag Fibrinol 1994;5:537-42.
10. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Timing of the administration of tranexamic acid for maximum
reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 2001;83:702-5.
11. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty:
a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 1996;78:434-40.
12. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999;57(6):1005-32.
13. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemelä HM, Mäntylä SK, et al. Tranexamic acid radically decreases
blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 1997;84:839-44.
14. Hiippala S, Strid L, Wennerstrand M, Arvela V, Mäntylä S, Ylinen J, et al. Tranexamic acid (Cyklokapron) reduces
perioperative blood loss associated with total knee arthroplasty. Br J Anaesth 1995;74(5):534-7.
15. Ralley FE, Berta D, Binns V, Howard J, Naudie DD. One intraoperative dose of tranexamic acid for patients having primary
hip or knee arthroplasty. Clin Orthop Relat Res 2010;468(7):1905-11. Epub 2010 Jan 9. Erratum in: Clin Orthop Relat Res
2010;468(5):1447.
16. Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, et al. Topical application of tranexamic
acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 20103;
92(15):2503-13.
17. Zhi-Gao Y, Wei-Ping C, Li-Dong W. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:
a meta-analysis. J Bone Joint Surg Am 2012; 94:1153-9.
18. Good L, Peterson E, Lisander B. Tranexamic acid decrease external blood loss but not hidden blood loss in total knee
replacement. Br J Anaesth 2003;90:596-9.
19. Orpen NM, Little C, Walker G, Crawfurd EJ. Tranexamic acid reduces early post-operative blood loss after total knee
arthroplasty: a prospective randomised controlled trial of 29 patients. Knee 2006;13:106-10.
20. Benoni G, Lethagen S, Fredin H. The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty.
Thromb Res 1997;85(3):195-206.
21. Molloy DO, Archbold HA, Ogonda L, McConway J, Wilson RK, Beverland DE. Comparison of topical fibrin spray and
tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial. J Bone Joint Surg Br
2007;89:306-9.
22. Sano M, Hakusi H, Kojima C, Akimoto T. Absorption and excretion of tranexamic acid following intravenous, intramuscular,
and oral administrations in healthy volunteers. Jpn J Clin Pharmacol Ther 1976;7:375 -82.
23. Ahlberg A, Eriksson O, Kjellman H. Diffusion of tranexamic acid to the joint. Acta Orthop Scand 1976;47:486-8.
24. Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results
of a meta-analysis of randomized controlled trials. Transfusion 2005; 45(8):1302-7.
25. Hynes M, Calder P, Scott G. The use of tranexamic acid to reduce blood loss during total knee arthroplasty. Knee 2003;10:375-
7.
2. Goodnough LT, Verbrugge D, Marcus RE. The relationship between hematocrit, blood lost and blood transfused in total knee
replacement. Am J Knee Surg 1995;8:83-7.
3. Mylod AG Jr, France MP, Muser DE, Parsons JR. Perioperative blood loss associated with total knee arthroplasty. A comparison
of procedures performed with and without cementing. J Bone Joint Surg Am 1990;72:1010-2.
4. Burkart BC, Bourne RB, Rorabeck CH, Kirk PG, Nott L. The efficacy of tourniquet release in blood conservation after total
knee arthroplasty. Clin Orthop Relat Res 1994;(299):147-52.
5. Lemaire R. Strategy for blood management in orthopedics and trauma surgery. J Bone Joint Surg Br 2008;90(9):1128-36.
6. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM. Tranexamic acid in total knee replacement: a systematic
review and meta-analysis. J Bone Joint Surg Br 2011;93:1577-85.
7. Benoni G, Bjorkman S, Fredin H. Application of pharmakinetic data from healthy volunteers for the prediction of plasma
concentrations of tranexamic acid in surgical patients. Clin Drug Invest 1995;10(5):280-7.
8. Camarasa MA, Olle G, Serra-Prat M, Martín A, Sánchez M, Ricós P, et al. Efficacy of aminocaproic, tranexamic acids in the
control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth 2006;96:576-82.
9. Longstaff C. Studies on the mechanisms of action of aprotinin and tranexamic acid as plasmin inhibitors and antifibrinolytic
agents. Blood Coag Fibrinol 1994;5:537-42.
10. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Timing of the administration of tranexamic acid for maximum
reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 2001;83:702-5.
11. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty:
a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 1996;78:434-40.
12. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999;57(6):1005-32.
13. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemelä HM, Mäntylä SK, et al. Tranexamic acid radically decreases
blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 1997;84:839-44.
14. Hiippala S, Strid L, Wennerstrand M, Arvela V, Mäntylä S, Ylinen J, et al. Tranexamic acid (Cyklokapron) reduces
perioperative blood loss associated with total knee arthroplasty. Br J Anaesth 1995;74(5):534-7.
15. Ralley FE, Berta D, Binns V, Howard J, Naudie DD. One intraoperative dose of tranexamic acid for patients having primary
hip or knee arthroplasty. Clin Orthop Relat Res 2010;468(7):1905-11. Epub 2010 Jan 9. Erratum in: Clin Orthop Relat Res
2010;468(5):1447.
16. Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, et al. Topical application of tranexamic
acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 20103;
92(15):2503-13.
17. Zhi-Gao Y, Wei-Ping C, Li-Dong W. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:
a meta-analysis. J Bone Joint Surg Am 2012; 94:1153-9.
18. Good L, Peterson E, Lisander B. Tranexamic acid decrease external blood loss but not hidden blood loss in total knee
replacement. Br J Anaesth 2003;90:596-9.
19. Orpen NM, Little C, Walker G, Crawfurd EJ. Tranexamic acid reduces early post-operative blood loss after total knee
arthroplasty: a prospective randomised controlled trial of 29 patients. Knee 2006;13:106-10.
20. Benoni G, Lethagen S, Fredin H. The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty.
Thromb Res 1997;85(3):195-206.
21. Molloy DO, Archbold HA, Ogonda L, McConway J, Wilson RK, Beverland DE. Comparison of topical fibrin spray and
tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial. J Bone Joint Surg Br
2007;89:306-9.
22. Sano M, Hakusi H, Kojima C, Akimoto T. Absorption and excretion of tranexamic acid following intravenous, intramuscular,
and oral administrations in healthy volunteers. Jpn J Clin Pharmacol Ther 1976;7:375 -82.
23. Ahlberg A, Eriksson O, Kjellman H. Diffusion of tranexamic acid to the joint. Acta Orthop Scand 1976;47:486-8.
24. Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results
of a meta-analysis of randomized controlled trials. Transfusion 2005; 45(8):1302-7.
25. Hynes M, Calder P, Scott G. The use of tranexamic acid to reduce blood loss during total knee arthroplasty. Knee 2003;10:375-
7.