Comparative analysis of two delivery methods of tranexamic acid for reducing bleeding in total knee arthroplasty

ZHAO Xiang; QI Dachun; AN Xinrong; GAO Tianqin; XU Chuang

doi:10.13506/j.cnki.jpr.2023.12.015

Abstract：Objective To compare and study the effects of multiple oral and multiple intravenous applications of tranexamic acid(TXA)on bleeding during total knee arthroplasty.Methods A total of 120 cases of initial unilateral total knee arthroplasty in our hospital from January 2019 to December 2021 were selected and divided into four groups(A,B,C and D)according to random number table method,with 30 cases in each group.All patients in the four groups were given TXA 1 g intravenously 5～10 min before incision.Group A:TXA 1 g was injected intravenously at 6,12 and 18 h,respective-ly,group B:TXA 2 g was administered orally at 4,10 and 16 h postoperatively,group C:equal doses of saline were adminis-tered intravenously at 6,12 and 18 h postoperatively.group D:equal doses of placebo were administered orally at 4,10 and 16 h postoperatively.Group D:equal doses of placebo were given orally at 4,10 and 16 h postoperatively.The general periop-erative data,total blood loss,occult blood loss,postoperative drainage,hemoglobin and hematocrit on postoperative days 1 and 3,postoperative transfusion rate,pulmonary embolism and venous thrombosis were compared among the four groups.Re-sults The total perioperative blood loss in groups A and B was(677.50±16.59)mL and(674.97±16.41)mL,respectively;The occult blood loss was:(579.77±12.48)mL and(576.00±16.44)mL;The postoperative drainage was(62.43±4.05)mL and(62.67±4.11)mL;The transfusion rate was 6.6%and 3.3%;All significantly lower than the control groups C and D;The difference was statistically significant(P<0.05),and the difference between group A and group B,group C and group D.There was no statistically significant difference(P>0.05)in a two-by-two comparison between group A and group B,group C and group D.The hemoglobin(HB)values and hematocrit(HCT)values in groups A and B were significantly higher than those in groups C and D at 1 and 3 days postoperatively,and the differences were statistically signif-icant(P<0.05),and a two-way comparison between groups A and B,groups C and D showed no statistically significant differences(P>0.05).There was significant difference in TXA medication cost among the four groups,group A(438.4 yuan/bit)>Group B(137.56yuan/bit)>Group Candgroup D(109.6yuan/bit),andothergeneraldatahadnostatisti-cal significance(P>0.05).After operation,there was 1 case of intermuscular venous thrombosis in group A and 1 case in group D,and no pulmonary embolism occurred.Conclusion Tranexamic acid after total knee arthroplasty is comparable to multiple oral doses and multiple intravenous drips,both of which can effectively reduce blood loss in the perioperative period of TKA,decrease the transfusion rate,and do not increase the incidence of postoperative complications.Oral administration has the advantages of low drug price,convenient use and no complications related to infusion.