Use of tranexemic acid on postoperative blood loss and transfusion requirements in patients undergoing total knee replacement

Background: Several techniques are available to minimize the likelihood of blood transfusion following total knee arthroplasty. Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip and total knee arthroplasties with or without cement. The objective of this study was to assess the efficacy of antifibrinolytic treatment along with other measures like saline adrenaline infusion, no drain, no tourniquet and hypotensive anaesthesia in reducing perioperative blood loss during total knee replacement.Methods: Between January 2011 to January 2016, seventy five consecutive patients who had given written informed consent, undergoing a TKR received tranexamic acid 15 mg/kg body weight intravenous 5 minutes before the skin incision and two doses afterwards (3 and 6 hours after the first dose respectively). TKR was performed in a routine fashion without tourniquet. The saline adrenaline (1:200000) was infiltrated into the skin subcutaneous tissue and capsule before skin incision. A routine closure was carried out without drain. Total blood loss including the hidden blood loss was calculated. All patients were monitored for anemia and postoperative thromboembolic complications.Results: The average total blood loss in study group is 433 ± 148 ml. This is much lesser than what other studies have reported. Mean reduction in hemoglobin levels (gm/dl) between preoperative and postoperative readings is 1.6 gm/dl. One patient had a postoperative DVT which was treated with rivaroxaban 20 mg OD for 6 weeks (oral anticoagulant). Conclusions: Antifibrinolytic agents like tranexamic acid used along with other measures reported in this study produces a significant decrease in blood loss in patients undergoing total knee replacement.

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Does Patella Resurfacing Affect Postoperative Blood Loss in Patients Undergoing Total Knee Replacement?

Techniques in Orthopaedics ◽

10.1097/bto.0000000000000328 ◽

2020 ◽

Vol 35 (2) ◽

pp. 134-136

Author(s):

Steven J. Girdler ◽

Christopher D. Glezos

Keyword(s):

Blood Loss ◽

Total Knee Replacement ◽

Knee Replacement ◽

Postoperative Blood Loss ◽

Total Knee

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Predicting Factors for Allogeneic Blood Transfusion and Excessive Postoperative Blood Loss after Single Low-Dosage Intra-Articular Tranexamic Acid Application in Total Knee Replacement

BioMed Research International ◽

10.1155/2017/2729487 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Paphon Sa-ngasoongsong ◽

Siwadol Wongsak ◽

Noratep Kulachote ◽

Pongsthorn Chanplakorn ◽

Patarawan Woratanarat ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Total Knee Replacement ◽

Tranexamic Acid ◽

Knee Replacement ◽

Postoperative Blood Loss ◽

Total Blood ◽

Predicting Factors ◽

Total Knee ◽

Low Bmi

Background.Recently, intra-articular tranexamic acid (IA-TXA) application has become a popular method for perioperative blood loss (PBL) reduction in total knee replacement (TKR). Nevertheless, through our knowledge, no previous studies had shown the correlation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT) after IA-TXA.Materials and Methods.A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period (2013-2014). Patient’s characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss (THL), estimated total blood loss (ETBL), and drainage volume per kg (DV/kg). Excessive PBL was defined as PBL that exceeded 90th percentile.Results. From multivariate analysis, low preoperative hemoglobin (Hb) level and body mass index (BMI) were the significant predictors of postoperative BT (p<0.0001and 0.003, resp.). Excessive THL significant associated with preoperative Hb (p<0.0001). Excessive ETBL significantly associated with preoperative Hb, height, preoperative range-of-motion, and creatinine clearance (p<0.05all). Low BMI and large prosthesis size were the significant predictors of excessive DV/kg (p=0.0001and 0.002, resp.).Conclusions. Low preoperative Hb and BMI were the significant risks of postoperative transfusion after TKR with IA-TXA. Moreover, multiple perioperative factors could result in higher PBL.

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Evaluation of tranexamic acid in reducing blood loss and transfusions in total knee replacement

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193832 ◽

2019 ◽

Vol 5 (5) ◽

pp. 899

Author(s):

Mirza Atif Baig ◽

Srujith Kommera

Keyword(s):

Blood Loss ◽

Total Knee Replacement ◽

Tranexamic Acid ◽

Knee Replacement ◽

Acid Group ◽

Control Group ◽

Blood Transfusions ◽

Reduce Blood Loss ◽

Transfusion Requirements ◽

Total Knee

Background: Total knee replacement (TKR) is associated with substantial blood loss and thus the need for blood transfusions. Risks and costs of allogenic blood transfusions requires strategies to reduce blood loss in surgery. The objective of this study was to assess the efficacy of tranexamic acid treatment in reducing blood loss and blood transfusion requirements during TKR.Methods: A randomized controlled trial was conducted on 60 patients who were operated for unilateral TKR from January 2016 to January 2019 in Shadan Institute of Medical Sciences. 30 patients were in each control and study groups. In study group 12 mg/kg bolus of tranexamic acid was given as a slow IV dose, 40 minutes before deflation of tourniquet followed by 1.2 mg/kg/hr infusion for 12 hours with standard treatment of hospital and compared to the control group. Later blood loss was compared both intra and post operatively. Fall in haemoglobin after surgery was also compared.Results: Total blood loss in tranexamic acid group was 543.3±184.85 ml (control group 685.83±176.74 ml) which is statistically significant (p<0.05). Blood loss was markedly decreased in tranexamic acid group (379.16±174 ml in tranexamic acid vs. 513.33±143.89 ml in control group) statistically significant (p<0.05).Conclusions: Tranexamic acid is an effective strategy to reduce blood loss in patients undergoing total knee replacement and thus minimizing the need for blood transfusions.

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Effect of Tourniquet upon Development of Intra- and Postoperative Complications in Total Knee Replacement in Patients Treated with Pradaxa

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201118442-44 ◽

2011 ◽

Vol 18 (4) ◽

pp. 42-44

Author(s):

Mikhail Vladimirovich Girkalo ◽

D M Puchin'yan ◽

O Yu Voskresenskiy ◽

A V Derevyanov ◽

A V Mandrov ◽

...

Keyword(s):

Blood Loss ◽

Total Knee Replacement ◽

Knee Replacement ◽

Anticoagulant Therapy ◽

Early Postoperative Period ◽

Postoperative Blood Loss ◽

Thromboembolic Complications ◽

Total Blood ◽

Pneumatic Tourniquet ◽

Total Knee

Results of comparative study of intra- and postoperative blood loss, rate of thromboembolic complications at total knee replacement with and without tourniquet application on the background of anticoagulant therapy with Pradaxa. It was shown that application of pneumatic tourniquet considerably decreased blood loss during the most laborious steps of operation but did not decreased the total blood loss and simultaneously increased the risk of thromboembolic complications development in the early postoperative period. Anticoagulant therapy including oral Pradaxa 220mg/day provided the convenience for the patient to continue thromboprophylaxis after discharge that greatly increased its efficacy.

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Combination of tranexamic acid and dexmedetomidine reduces postoperative blood loss in patients undergoing bilateral total knee replacement - A randomized controlled study

MedPulse International Journal of Anesthesology ◽

10.26611/1015716 ◽

2018 ◽

Vol 7 (1) ◽

pp. 32-35

Author(s):

Koramutla Pradeep Kumar ◽

◽

J Subhashree ◽

Chittaranjan Sahu ◽

G Jagadesh ◽

...

Keyword(s):

Blood Loss ◽

Total Knee Replacement ◽

Tranexamic Acid ◽

Knee Replacement ◽

Randomized Controlled Study ◽

Postoperative Blood Loss ◽

Controlled Study ◽

Randomized Controlled ◽

Total Knee ◽

Bilateral Total Knee Replacement

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An In Vivo Study of Low-Dose Intra-Articular Tranexamic Acid Application with Prolonged Clamping Drain Method in Total Knee Replacement: Clinical Efficacy and Safety

BioMed Research International ◽

10.1155/2015/164206 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Paphon Sa-ngasoongsong ◽

Pongsthorn Chanplakorn ◽

Siwadol Wongsak ◽

Krisorn Uthadorn ◽

Tanapong Panpikoon ◽

...

Keyword(s):

Blood Loss ◽

Total Knee Replacement ◽

Tranexamic Acid ◽

Knee Replacement ◽

Low Dose ◽

Postoperative Blood Loss ◽

Systemic Absorption ◽

Drainage Fluid ◽

Significant Difference ◽

Total Knee

Background. Recently, combined intra-articular tranexamic acid (IA-TXA) injection with clamping drain method showed efficacy for blood loss and transfusion reduction in total knee replacement (TKR). However, until now, none of previous studies revealed the effect of this technique on pharmacokinetics, coagulation, and fibrinolysis.Materials and Methods. An experimental study was conducted, during 2011-2012, in 30 patients undergoing unilateral TKR. Patients received IA-TXA application and then were allocated into six groups regarding clamping drain duration (2-, 4-, 6-, 8-, 10-, and 12-hours). Blood and drainage fluid were collected to measure tranexamic acid (TXA) level and related coagulation and fibrinolytic markers. Postoperative complication was followed for one year.Results. There was no significant difference of serum TXA level at 2 hour and 24 hour among groups(p<0.05). Serum TXA level at time of clamp release was significantly different among groups with the highest level at 2 hour(p<0.0001). There was no significant difference of TXA level in drainage fluid, postoperative blood loss, blood transfusion, and postoperative complications(p<0.05). Conclusions. Low-dose IA-TXA application in TKR with prolonged clamping drain method is a safe and effective blood conservative technique with only minimal systemic absorption and without significant increase in systemic absorption over time.

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A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182034 ◽

2018 ◽

Vol 4 (4) ◽

pp. 532 ◽

Cited By ~ 1

Author(s):

Sayyied J. Kirmani ◽

Mark Middleton ◽

Andreas Fontalis ◽

Raka Srivastava ◽

Feroz Dinah

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Total Knee Replacement ◽

Knee Replacement ◽

The Body ◽

Operative Blood Loss ◽

Primary Total Knee Replacement ◽

Transfusion Requirements ◽

Total Knee ◽

Primary Total Knee

Background: Primary total knee replacement (TKR) has traditionally been carried out with the use of a tourniquet. More recent trends towards performing the surgery without a tourniquet have had some support in the literature and may improve patient recovery.Methods: A retrospective cohort of 198 consecutive primary TKRs from our institution were identified and analysed, 52 used a tourniquet and 146 did not. All TKRs also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, topical adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion.Results: Analysis demonstrated a statistically significant reduction in estimated intra-operative blood loss when a tourniquet was used (p<0.001). However, overall blood loss indicated by the haemoglobin drop after surgery was not significantly affected by tourniquet use (p=0.342). Transfusion requirements were also similar among the groups (4.8% vs. 5.8%) and no tendency was suggested towards an increased rate of transfusion in the non-tourniquet group.Conclusions: Our study shows that although estimated intra-operative blood loss is increased without a tourniquet, total blood loss as measured by haemoglobin levels is no different for primary TKRs that use a tourniquet and those that do not. Furthermore there is no difference in post-operative blood transfusion rates. It is our hope that this study will add to the body of evidence for surgeons to consider no longer using a tourniquet for primary TKR.

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