Abstract
Despite improvements in surgical technique, blood loss continues to be an issue following TJR in 2013. Peri-operative blood loss averages between 1000 and 1500 cc during THR and TKR. Multiple methods have been employed in attempts to minimise this loss. Concepts such as hypotensive anesthesia, tourniquet use, intraoperative blood salvage and autologous pre-donation and postoperative re-infusion drains as well as the use of bipolar sealants, fibrin sprays and thrombin agents have been tried with varying degrees of success.
Recently there has been a surge of interest in the use of antifibrinolytics such as Tranexamic Acid (TXA), Aprotinin and Aminocaproic Acid. These medications have a long history of use in other fields such as cardiac and oral surgery but are just recently being utilised following TJR. Of these medications, TXA has been by far the best studied.
TXA is a synthetic amino acid that inhibits fibrinolysis by competitively and reversibly blocking the Lysine binding sites on plasminogen. This inhibits its activation and slows the conversion from plasminogen to plasmin and this prohibits the binding of plasmin to fibrin and the subsequent dissolving of clot formation.
TXA can be used either topically or intravenously and there are more than 50 clinical papers that have evaluated the effectiveness of TXA in TJR. There is abundant scientific data to support its safety with minimal increased risk of thrombosis and its use should be considered as a safe, effective and economical means of reducing blood loss in TJR in 2013.
