Influence of application method of tranexamic acid on the blood loss after total knee arthroplasty
ZHANG Xiao-dong
LI Lei
WANG Guo-zhu
XIAO Bin
Abstract：Objective To investigate the influence of application method of tranexamic acid ( TXA ) on the blood loss after total knee arthroplasty, and to assess the safety. Methods We chose 78 cases in accordance with the inclusive criteria who were treated with unilateral total knee arthroplasty from March 2015 to July 2016. According to the block randomization method, the patients were divided into Group A, Group B and Group C. The patients of Group A were injected intravenously with 100 ml TXA solution ( TXA 1 g ) at 10 minutes before the tourniquet was released. In Group B, before the tourniquet was released and after the prosthesis was implanted, the patients were injected with 100 ml TXA solution ( TXA 1 g ) in the incision, which was soaked for 5 minutes. In Group C, intra-articular incision of 100 ml TXA solution ( TXA 1 g ) was carried out through the drainage tube after the joint capsule was sutured, and the drainage tube was temporarily clamped for 2 hours. The intraoperative blood loss, hidden blood loss, total blood loss, postoperative total volume of drainage, postoperative hemoglobin level, blood transfusion and adverse reactions were compared among the 3 groups. Results Intraoperative blood loss: Group A ( 134.88 ± 12.12 ) ml, Group B ( 131.19 ± 11.02 ) ml and Group C ( 132.85 ± 10.21 ) ml. There were no statistically significant differences ( P = 0.49 > 0.05 ). Postoperative total volume of drainage: Group A ( 252.27 ± 57.42 ) ml, Group B ( 208.14 ± 38.62 ) ml and Group C ( 158.5 ± 20.70 ) ml. The postoperative total volume of drainage in Group B and Group C was lower than that in Group A ( P = 0.00 < 0.05 ). Hidden blood loss: Group A ( 351.03 ± 89.87 ) ml, Group B ( 288.96 ± 67.13 ) ml and Group C ( 180.26 ± 31.33 ) ml. The hidden blood loss in Group B and Group C was lower than that in Group A ( P = 0.00 < 0.05 ). Total blood loss: Group A ( 550.65 ± 87.91 ) ml, Group B ( 458.12 ± 77.30 ) ml and Group C ( 366.89 ± 70.69 ) ml. The total blood loss in Group B and Group C was lower than that in Group A ( P = 0.000 < 0.05 ). At 12, 24 and 48 hours after the operation, mean hemoglobin reduction: Group A ( 24.62 ± 3.51 ) g / L, Group B ( 21.84 ± 2.81 ) g / L and Group C ( 17.43 ± 2.24 ) g / L. The hemoglobin reduction in Group B and Group C was less than that in Group A ( P = 0.00 < 0.05 ). In all the postoperative blood transfusion cases, there were 4 cases in Group A, 5 cases in Group B and 2 cases in Group C. The amount of blood transfusion in Group B and Group C was less than that in Group A ( P = 0.02 < 0.05 ). There were no complications in the 3 groups such as postoperative infection, pulmonary embolism or deep venous thrombosis of the lower extremity. Conclusions There is an obvious correlation between the application method of TXA in total knee arthroplasty and postoperative blood loss. The hemostatic effect of local articular cavity injection is better than that of intravenous fluids and partial immersion.
Keywords：Tranexamic acidDrug therapyArthroplastyreplacementkneeKnee prosthesis
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 896-899 )