Abstract
Abstract
By next summer the number of patients in the tranexamic acid group will be much higher, probably around 50–60.
Purpose
Tranexamic acid has been extensively studied in single total knee and total hip replacement patients. It has been found to reduce blood loss and transfusion rates, with no increase in the rate of venous thromboembolism.
This study was undertaken to determine whether tranexamic acid reduces blood loss and the rate of blood transfusion after bilateral total knee replacement, which has a much higher transfusion rate.
Method
The preoperative haemoglobin and the lowest postoperative haemoglobin for 30 consecutive bilateral tkr patients who received tranexamic acid was recorded. These were compared with a a consecutive series of 262 historic controls that did not receive tranexamic acid. All patients were operated on by the same surgeon. The surgical procedure was essentially unchanged throughout the study period. The decision to transfuse was made by the hospitalist, who did not know whether the patient received tranexamic acid.
Data calculated included the percentage drop in haemoglobin, and the transfusion rate for each group.
A subset of patients who were anaemic preoperatively (Hb < 125) were compared for each group.
Results
For the control group, which did not receive tranexamic acid, the average preoperative haemoglobin was 138, and dropped to 85 postoperatively. This represented a 38% drop in haemoglobin. Of the 262 patients, 105 required transfusion, giving a transfusion rate of 40%. The average number of units transfused was 1.8.
For the study group, which received tranexamic acid, the average preoperative haemoglobin was 133, and dropped to 97 postoperatively. This represented a 27% drop in haemoglobin. Of the 30 patients, only one required transfusion, giving a transfusion rate of 4%. That one patient required only one unit of blood.
For the patients who were anaemic preoperatively (Hb < 125) the transfusion rate for the control group was 97%, and for the study group was 20% (1/5).
Conclusion
Tranexamic acid markedly reduces blood loss and the rate of transfusion for patients undergoing bilateral total knee replacement.
