Effect comparison of intravenous versus topical application of tranexamic acid on blood loss and blood transfusion in elderly patients with total knee arthroplasty

YANG Jian-xiang; FAN Yan-mei; ZHAO Jie; GUO Huan-lai; WU Hong-yang

doi:10.3969/j.issn.1009-4237.2017.05.010

Abstract：Objective To observe and compare the effects of intravenous versus topical application of tranexamic acid on blood loss and blood transfusion in elderly patients with total knee arthroplasty (TKA). Methods One hundred and twenty patients who received unilateral TKA in the Second Hospital of Bazhou City between Mar.2015 and Feb.2016 were enrolled in this study,and assigned to intravenous application group and topical application group,with 60 cases in each group.There were 53 males and 67 females, with age ranging from 60 to 83 years (mean,68.17 years).The patients in the topical application group were injected intra-articularly 0.5g tranexamic acid after closing articular cavity,and the patients in the intravenous application group were given 10mg/kg tranexamic acid by intravenous injection at 15 min before tourniquet pressure.The levels of Hb at before operation and postoperative 1d,3d,5d were observed and recorded.The levels of FIB,PT,APTT,D-D at before operation and postoperative 6h were observed and recorded.The intraoperative blood loss, flow amount postoperative 12h,total flow amount,hidden blood loss, total amount of blood loss and average amount of blood transfusion were compared between the two groups. Results The preoperative Hb levels had no difference between the two groups (P>0.05).The Hb level at postoperative 1d,3d,5d in topical application group was significantly higher than that in intravenous application group (P<0.05).The levels of FIB,PT,APTT before operation and postoperative 6h had no statistical significance (P>0.05);in the two groups.The D-D levels at postoperative 6h were higher than those of before operation in two groups,and the differences were statistically significant (P<0.05).The flow amount at postoperative 12h,total flow amount,total amount of blood loss and average amount of blood transfusion in topical application group were higher than those in intravenous application group,and the differences were statistically significant (P<0.05). Conclusion Compared with intravenous application of tranexamic acid,the topical application of tranexamic acid could significantly reduce the amount of postoperative blood loss and blood transfusion in elderly patients with TKA,and is conducive to the clinical rehabilitation of patients.