A PROSPECTIVE RANDOMIZED SELF-CONTROLLED STUDY ON EFFECT OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS IN TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANGZida ,  ZHANGWenming , LIWenbo , BAIGuochang , ZHANGChaofan , LINJianhua

Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350001, P. R. China;

Corresponding author：

ZHANGWenming, Email: Zhangwm0591@163.com

Keywords：

Total knee arthroplasty; Tranexamic acid; Blood loss; Self-control study

DOI：

10.7507/1002-1892.20150060

Video：

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Objective To investigate the safety and efficiency of intravenous tranexamic acid (TXA) to reduce blood loss in total knee arthroplasty (TKA). Methods A prospective, randomized, self-controlled study was carried out on 60 patients scheduled for bilateral TKA between January 2012 and December 2013. TXA (10 mg/kg) was injected intravenously approximately 10 minutes before tourniquet release when TKA was performed on one side (TXA group), and TXA was not used on the other side (control group). No significant difference was found in the preoperative hemoglobin (Hgb), platelet (PLT) count, prothrombin time (PT), and activated partial thromboplastin time (APTT) between 2 groups (P>0.05). The amount of drainage, the total blood loss, the hidden blood loss, the postoperative Hgb, the amount of blood transfusion, the ratio of blood transfusion, and the incidence of vein thrombosis embolism (VTE) were compared between 2 groups. Results The amount of drainage and total blood loss were significantly less in the TXA group than in control group (P<0.05), and the Hgb was significantly lower in the control group than in the TXA group at 6 hours, 1, 3, and 7 days after operation (P<0.05). There was no significant difference in the hidden blood loss between 2 groups (t=1.157, P=0.252). The ratio of blood transfusion was significantly less in TXA group (6.7%, 4/60) than in control group (21.7%, 13/60)(P=0.034). The total amount of blood transfusion was 14 units in TXA group, which was significantly less than that of control group (38 units) (P=0.004). Deep vein thrombosis occurred in 3 cases in 2 groups respectively, showing no significant difference (P=1.000). There was no symptomatic pulmonary embolism. All patients were followed up for 8-17 months, with an average of 13.7 months. No new VTE case was found during the follow-up period. Conclusion Intravenous injection of TXA (10 mg/kg) at 10 minutes before tourniquet release in TKA is effective in reducing perioperative blood loss, amount of blood transfusion, and ratio of transfusion, and it will not increase the risk of VTE.

Citation： HUANGZida, ZHANGWenming, LIWenbo, BAIGuochang, ZHANGChaofan, LINJianhua. A PROSPECTIVE RANDOMIZED SELF-CONTROLLED STUDY ON EFFECT OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS IN TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 280-283. doi: 10.7507/1002-1892.20150060 Copy

1.	Kim TK, Chang CB, Kang YG, et al. Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol:a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8):1870-1878.
2.	Ha DJ, Lee HS, Ha JH, et al. The effect of autotransfusion system in minimally invasive total knee arthroplasty. Knee Surg Relat Res, 2013, 25(2):65-70.
3.	Kim TK, Chang CB, Koh IJ. Practical issues for the use of tranexamic acid in total knee arthroplasty:a systematic review. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8):1849-1858.
4.	Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis. J Bone Joint Surg (Am), 2012, 94(13):1153-1159.
5.	Gandhi R, Evans HM, Mahomed SR, et al. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty:a meta-analysis. BMC Res Notes, 2013, 6:184.
6.	Gross JB. Estimating allowable blood loss:corrected for dilution. Anesthesiology, 1983, 58(3):277-280.
7.	Krishnamurti C, Vukelja SJ, Alving BM. Inhibitory effects of lysine analogues on t-PA induced whole blood clot lysis. Thromb Res, 1994, 73(6):419-430.
8.	Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty:a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res, 2012, 470(9):2605-2612.
9.	Howes JP, Sharma V, Cohen AT. Tranexamic acid reduces blood loss after knee arthroplasty. J Bone Joint Surg (Br), 1996, 78(6):995-996.
10.	MacGillivray RG, Tarabichi SB, Hawari MF, et al. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty:a prospective, randomized double blind study. J Arthroplasty, 2011, 26(1):24-28.
11.	Lin PC, Hsu CH, Huang CC, et al. The blood-saving effect of tranexamic acid in minimally invasive total knee replacement:is an additional pre-operative injection effective? J Bone Joint Surg (Br), 2012, 94(7):932-936.
12.	胡旭栋, 周宗科, 裴福兴, 等. 全膝关节置换围手术期氨甲环酸不同使用方法的有效性和安全性. 中华骨科杂志, 2014, 34(6):599-604.
13.	黄晓楠, 张勇. 前瞻性随机对照研究全膝关节置换术中使用氨甲环酸的临床疗效. 中华关节外科杂志(电子版), 2014, 8(6):718-722.
14.	张延杰, 郝军, 高文香. 不同剂量氨甲环酸对全膝关节置换术后失血量的影响. 山东医药, 2013, 53(19):53-55.
15.	郭建斌. 人工关节置换术后下肢深静脉血栓的血液学检测与相关危险因素分析. 西安:第四军医大学, 2013.
16.	姚晨, 史冬泉, 蒋青. 人工关节置换术后深静脉血栓形成的基因多态性研究进展. 中华外科杂志, 2009, 47(11):871-873.
17.	Dahuja A, Dahuja G, Jaswal V, et al. A prospective study on role of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty and its effect on coagulation profile. J Arthroplasty, 2014, 29(4):733-735.
18.	Xu Q, Yang Y, Shi P, et al. Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty. Biosci Trends, 2014, 8(3):169-175.
19.	Lin SY, Chen CH, Fu YC, et al. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty. J Arthroplasty, 2014.[Epub ahead of print].

1. Kim TK, Chang CB, Kang YG, et al. Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol:a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8):1870-1878.
2. Ha DJ, Lee HS, Ha JH, et al. The effect of autotransfusion system in minimally invasive total knee arthroplasty. Knee Surg Relat Res, 2013, 25(2):65-70.
3. Kim TK, Chang CB, Koh IJ. Practical issues for the use of tranexamic acid in total knee arthroplasty:a systematic review. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8):1849-1858.
4. Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis. J Bone Joint Surg (Am), 2012, 94(13):1153-1159.
5. Gandhi R, Evans HM, Mahomed SR, et al. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty:a meta-analysis. BMC Res Notes, 2013, 6:184.
6. Gross JB. Estimating allowable blood loss:corrected for dilution. Anesthesiology, 1983, 58(3):277-280.
7. Krishnamurti C, Vukelja SJ, Alving BM. Inhibitory effects of lysine analogues on t-PA induced whole blood clot lysis. Thromb Res, 1994, 73(6):419-430.
8. Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty:a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res, 2012, 470(9):2605-2612.
9. Howes JP, Sharma V, Cohen AT. Tranexamic acid reduces blood loss after knee arthroplasty. J Bone Joint Surg (Br), 1996, 78(6):995-996.
10. MacGillivray RG, Tarabichi SB, Hawari MF, et al. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty:a prospective, randomized double blind study. J Arthroplasty, 2011, 26(1):24-28.
11. Lin PC, Hsu CH, Huang CC, et al. The blood-saving effect of tranexamic acid in minimally invasive total knee replacement:is an additional pre-operative injection effective? J Bone Joint Surg (Br), 2012, 94(7):932-936.
12. 胡旭栋, 周宗科, 裴福兴, 等. 全膝关节置换围手术期氨甲环酸不同使用方法的有效性和安全性. 中华骨科杂志, 2014, 34(6):599-604.
13. 黄晓楠, 张勇. 前瞻性随机对照研究全膝关节置换术中使用氨甲环酸的临床疗效. 中华关节外科杂志(电子版), 2014, 8(6):718-722.
14. 张延杰, 郝军, 高文香. 不同剂量氨甲环酸对全膝关节置换术后失血量的影响. 山东医药, 2013, 53(19):53-55.
15. 郭建斌. 人工关节置换术后下肢深静脉血栓的血液学检测与相关危险因素分析. 西安:第四军医大学, 2013.
16. 姚晨, 史冬泉, 蒋青. 人工关节置换术后深静脉血栓形成的基因多态性研究进展. 中华外科杂志, 2009, 47(11):871-873.
17. Dahuja A, Dahuja G, Jaswal V, et al. A prospective study on role of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty and its effect on coagulation profile. J Arthroplasty, 2014, 29(4):733-735.
18. Xu Q, Yang Y, Shi P, et al. Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty. Biosci Trends, 2014, 8(3):169-175.
19. Lin SY, Chen CH, Fu YC, et al. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty. J Arthroplasty, 2014.[Epub ahead of print].

Chinese Journal of Reparative and Reconstructive Surgery

A PROSPECTIVE RANDOMIZED SELF-CONTROLLED STUDY ON EFFECT OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS IN TOTAL KNEE ARTHROPLASTY

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