EFFECTIVENESS OF TRANEXAMIC ACID FOR REDUCING BLOOD LOSS IN TOTAL KNEE ARTHROPLASTY – INTRAVENOUS ADMINISTRATION WITH DRAIN-CLAMPING METHOD

Abstract

The purpose of this study was to elucidate the hemostatic effects of tranexamic acid (TA) in patients undergoing total knee arthroplasty (TKA) performed with different three methods.

The subjects were 89 patients (10 males, 79 females; mean age at surgery 74 years old) who underwent TKA for osteoarthritic knees in our department between April 2006 and October 2007. A cemented prosthesis (NexGen LPS flex, Zimmer) was used in all cases. The subjects were divided into three groups; Group A (n=39), in whom intravenous administration of TA (1 000 mg) 15 minutes before tourniquet release and a drain-clamping method [DC; joint filled with 50 ml of fluid that contained TA (1 000 mg, 10 ml) and 40 ml of physiological saline just after surgery] were performed, as reported by Prof. Otani (Keio Univ., Tokyo, Japan) in 2005; Group B (n=20), who had the same protocol as Group A, except that the DC Joint was filled with a total of 50 ml physiological saline alone; and group C (n=30), who received DC alone with 50 ml of physiological saline and no intravenous administration of TA. The parameters evaluated were the amounts of intra-operative bleeding, bleeding after 24 hours, total bleeding (intra- and post-operative), and changes in Hb levels between before surgery and 1 week after surgery. Statistical analyses were performed using a Mann-Whitney U-test, with P-values greater than 0.05 considered to be significant.

No differences were observed in the amount of bleeding during the TKA among the groups. In contrast, bleeding at 24 hours after surgery and total amounts of bleeding were significantly lower in Group A (281 and 695ml, respectively) as compared to Group B (337 and 868 ml, respectively) and Group C (650 and 1043 ml, respectively) (p< 0.01). In addition, Hb levels at 1 week after surgery were reduced by 1.8 g/dl in Group A, as compared to 2.3 and 3.0 g/dl in Groups B and C, respectively, demonstrating a significantly lower amount of reduction in Group A (p< 0.01).

The effect of TA for reducing blood loss in TKA is widely recognized. In the present study, concomitant use of an intravenous administration and infiltration into the joint (via DC) significantly reduced blood loss during and after TKA. Furthermore, allogenic blood transfusion could be avoided in all patients (Group A) who underwent that protocol. In our study, even when given intra-operatively, such as intravenous administration and infiltration, there were no complications. Nevertheless, when used during the post-operative course, careful attention should be paid to prevent such problems. In order to reduce blood loss during and after TKA, it is important to elucidate the optimal conditions, volume, and timing of administration of TA in future studies.