DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20210624

Retrospective comparative study of IV+ local tranexamic acid versus IV tranexamic acid only in primary total knee replacement

Sanil G. Kamat, Rohan Dessai

Abstract


Background: The study is to compare the immediate post-operative outcomes with use of intravenous (IV) tranexamic acid (TXA) versus IV and local TXA combination in primary unilateral total knee arthroplasty. Study comprised of 72 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and post op blood loss in drain, fall of haemoglobin levels and need of blood transfusion was recorded. The results were statistically compared. The mean blood loss fall in HB levels and need of blood transfusions revealed statistically significant differences.

Methods: Total 72 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 (IV only): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet. Group 2 (IV + Local): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet and 1 gm Tranexamic Acid in 50 ml saline locally at the time of closure.

Results: It was observed that higher post op blood loss, higher fall in haemoglobin (HB) levels and higher requirement of blood transfusions were associated with group 1 as compared to 2.

Conclusions: The study inferred that the combination of local and systemic tranexamic acid was superior than systemic administration alone with lower post op blood loss, lower rates of blood transfusion and lower fall in haemoglobin levels without any added complications.


Keywords


Total knee replacement, Tranexamic acid, Haemoglobin, Blood transfusion

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References


Y. Kalairajah,A. J. Cossey,G. M. Verrall,A. J. Spriggins. The Journal of Bone and Joint Surgery. British volumeVol. 87-B, No. 11KneeFree Access Blood loss after total knee replacement. 2005.

Risberg B. The response of the fibrinolytic system in trauma. Acta Chir Scand Suppl. 1985;522:245-71.

Janssens M, Joris J, David JL, Lemaire R, Lamy M. High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery. Anesthesiology. 1994;80:23-9.

Kruithof EK, Nicolosa G, Bachmann F. Plasminogen activator inhibitor 1: Development of a radioimmunoassay and observations on its plasma concentration during venous occlusion and after platelet aggregation. Blood. 1987;70:1645-53.

Nakahara M, Sakahashi H. Effect of application of a tourniquet on bleeding factors in dogs. J Bone Joint Surg Am. 1967;49:1345-51.

Klenerman L, Chakrabarti R, Mackie I, Brozovic M, Stirling Y. Changes in haemostatic system after application of a tourniquet. Lancet. 1977;1:970-2.

Petaja J, Myllynen P, Myllyla G, Vahtera E. Fibrinolysis after application of a pneumatic tourniquet. Acta Chir Scand. 1987;153:647-51.

Matthew R Bong, Vipul Patel,Eric Chang, Paul S Issack. Risks associated with blood transfusion after total knee arthroplasty. The Journal of Arthroplasty. 2004;19(3):281-7.

de Leede-van der Maarl MG, Hilkens P, Bosch F. The epileptogenic effect of tranexamic acid. J Neurol. 1999;246:843.

Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J.. Management of bleeding following major trauma: an updated European guideline. Crit Care. 2010;14:R52.

McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012;72:585-617.

Bundesamt für Sicherheit im Gesundheitswesen . SmPC Cyklokapron. 2017.

Tian P, Liu W-b, Li Z-j, Xu G-J, Huang Y-T, Ma X-l.The efficacy and safety of tranexamic acid in revision total knee arthroplasty: a meta-analysis, BMC Musculoskelet Disord. 2017;18:273.

Levine BR, Haughom BD, Belkin MN. Weighted versus uniform dose of tranexamic acid in patients undergoing primary, elective knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2014;29(9Suppl):186-88.

Iwai T, Tsuji S, Tomita T. Repeat-dose intravenous tranexamic acid further decreases blood loss in total knee ar-throplasty. Int Orthop. 2013;37:441-45.

Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthro-plasty: A prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012;470:2605-12.

Alshryda S, Sarda P, Sukeik M. Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br. 2011;93:1577-585.

Zhang H, Chen J, Chen F. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2012;20:1742-752.

Panteli M, Papakostidis C, Dahabreh Z. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee. 2013;20:300-09.

Wang H, Shen B, Zeng Y. Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. Knee. 2014;21:987-93.

Alshryda S, Sukeik M, Sarda P. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J. 2014;96-B:1005-015.

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;22:1849-858.

Wu Q, Zhang HA, Liu SL. Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials. Eur J Orthop Surg Traumatol. 2015;25:525-41.

Shemshaki H, Nourian SM, Nourian N. One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Arch Orthop Trauma Surg. 2015;135:573-88.

Yue C, Pei F, Yang P. Effect of topical tranexamic acid in reducing bleeding and transfusions in TKA. Orthopedics. 2015;38:315-24.

Jain NP, Nisthane PP, Shah NA. Combined administration of systemic and topical tranexamic acid for total knee arthroplasty: can it be a better regimen and yet safe? A randomized controlled trial. J Arthroplasty. 2016;31:542-47.

Aguilera X, Martínez-Zapata MJ, Hinarejos P. Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial. Arch Orthop Trauma Surg. 2015;135:1017-025.

Shen PF, Hou WL, Chen JB. Effectiveness and safety of tranexamic acid for total knee arthroplasty: a prospective randomized controlled trial. Med Sci Monit. 2015;21:576-81.

Hourlier H, Reina N, Fennema P. Single dose intravenous tranexamic acid as effective as continuous infusion in primary total knee arthroplasty: a randomised clinical trial. Arch Orthop Trauma Surg. 2015;135:465-71.

Karaaslan F, Karaoğlu S, Mermerkaya MU, et al. Reducing blood loss in simultaneous bilateral total knee arthroplasty: combined intravenous-intra-articular tranexamic acid administration. A prospective randomized controlled trial. Knee. 2015;22:131–135.

Carvalho LH, Jr, Frois Temponi E, Machado Soares LF. Bleeding reduction after topical application of tranexamic acid together with Betadine solution in total knee arthroplasty. A randomised controlled study. Orthop Traumatol Surg Res. 2015;101:83-87.

Lin SY, Chen CH, Fu YC. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty. J Arthroplasty. 2015;30:776-80.

Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial. J Bone Joint Surg Am. 2014;96:1937-944.

Yang Y, Lv YM, Ding PJ. The reduction in blood loss with intra-articular injection of tranexamic acid in unilateral total knee arthroplasty without operative drains: a randomized controlled trial. Eur J Orthop Surg Traumatol. 2015;25:135-39.

Huang Z, Ma J, Shen B. Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2014;29:2342-346.

Soni A, Saini R, Gulati A. Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty. J Arthroplasty. 2014;29:1525-527.

Patel JN, Spanyer JM, Smith LS. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty. 2014;29:1528-531.

Sarzaeem MM, Razi M, Kazemian G. Comparing efficacy of three methods of tranexamic acid administration in reducing haemoglobin drop following total knee arthroplasty. J Arthroplasty. 2014;29:1521-524.

Sa-Ngasoongsong P, Wongsak S, Chanplakorn P. Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial. BMC Musculoskelet Disord. 2013;14:340.

Alshryda S, Mason J, Vaghela M. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K) J Bone Joint Surg Am. 2013;95:1961-968.

Georgiadis AG, Muh SJ, Silverton CD. A prospective double-blind placebo controlled trial of topical tranexamic acid in total knee arthroplasty. J Arthroplasty. 2013;28(Suppl 8):78-82.

Lee SH, Cho KY, Khurana S. Less blood loss under concomitant administration of tranexamic acid and indirect factor Xa inhibitor following total knee arthroplasty: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2013;21:2611-617.

Seo JG, Moon YW, Park SH. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21:1869-74.

Chareancholvanich K, Siriwattanasakul P, Narkbunnam R. Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2012;13:124.

Lin PC, Hsu CH, Huang CC. 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;94:932-36.

Roy SP, Tanki UF, Dutta A. Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20:2494-501.

Lin PC, Hsu CH, Chen WS. Does tranexamic acid save blood in minimally invasive total knee arthroplasty? Clin Orthop Relat Res. 2011;469:1995-002.

Ishida K, Tsumura N, Kitagawa A. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011;35:1639-645.

A Sundström,H Kieler, L Alfredsson. The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case–control study using the General Practice Research Database BJOG. An International J Obstetr Gynaecol. 2011;116(1).