Abstract
PURPOSE OF STUDY
20-70% of patients need blood transfusion postoperatively. There remain safety concerns regarding allogenic blood transfusion. Tranexamic acid (TA) is a synthetic antifibrinolytic agent that has been successfully used to stop bleeding in other specialties. We applied TA topically prior to the wound closure to find out the effect on blood loss as well as need for subsequent blood transfusion. This method of administration is quick, easy, has less systemic side effect and provides a higher concentration at the bleeding site.
MATERIALS AND METHODS
A double blind randomised controlled trial of 154 patients who underwent unilateral primary cemented total knee replacement. Patients were randomised into tranexamic acid group (1g drug mixed with saline to make up 20mls) or placebo (20ml 0.9% saline). The administration technique and drain protocol was standardised for all patients. Drain output was measured at 24 hours, and both groups compared for need of Blood transfusion. Outcome measures - blood loss, transfusion, complications, Euroqol and Oxford Knee Score.
RESULTS
The two groups were comparable in age, weight, height, BMI, and Tourniquet time. There was significant difference in the amount of blood loss and blood transfusion in favour of tranexamic acid (p=0.001 and 0.007 respectively). Fourteen patients needed blood transfusion (ranged from 2 to 6 units). Thirteen were in the Placebo group and only one in the Tranexamic acid. There was no significant difference among other outcomes, in particular complications rates such as DVT and PE. Use of Tranexamic acid is recommended as routine to reduce bleeding and blood transfusion rates following primary Total Knee replacement.
