Abstract
Background
Tranexamic acid (TA) in total knee replacement surgery (TKR) has shown marked reduction in bleeding and blood transfusion. There are little data on TA in revision TKR. From February 2008 all patients having primary or revision TKR received TA 10mg/kg × 2. We whished to evaluate the effect and possible complications of TA.
Patients and Methods
49 patients had revision TKR from January to August 2010. 21 patients (group I) operated before the regular use of TA were compared to 28 patients (group II) receiving TA. The groups were compared according to bleeding, blood transfusion, postoperative complication and type of revision. Revision TKR was compared to 157 primary TKR (94 operated without TA (group III) and 63 who received TA (group IV).
Results
Group I: Preoperative Hgl 13.6g/dl (9.2–15.3), reduction in hgl 3.9g/dl (1.0–5.7), bleeding 1040ml (380–2100). 6 patients (28.6%) needed blood transfusion. 7 patients were admitted to cell-saver and were given mean 400 ml blood (150–730).
There were 6 revisions from uni-prostheses to TKR and 15 was revision of TKR. There was no difference in bleeding between this to groups (980ml/1030ml).
Group II: Preoperative Hgl 14.2g/dl (11.2–18.6), reduction in hgl 3.3g/dl (1.4–8.3), bleeding 490ml (120–1050) (47.1% reduction in bleeding volume (p<0,002)). One patient (3.4%) needed blood transfusion.
There was 8 revisions from uni-prostheses to TKR and 21 was revision of TKR. There was no difference in bleeding between this two groups (510ml/570ml).
Group III: Preoperative Hgl 14.2g/dl (10.1–17.4), reduction in Hgl 3.5g/dl (1.1–7.7), bleeding 1048ml (50–2230). 15 patients (16%) needed blood transfusion.
Group IV: Preoperative Hgl 13.7g/dl (11.6–18.1), reduction in Hgl 2.76g/dl (1.2–4.8) (p=0,014), bleeding 370ml (130–960) (64.5% reduction in volume (p<0,002)). 2 patients (3%) needed blood transfusion. (p=0,004)).
There was no statistically significant difference in bleeding between primary and revision TKR (p=0.18).
Conclusion
Our results shows that TA reduces bleeding and the need for blood transfusion markedly. The TA groups had no increase in any complications.
