Background: Total knee arthroplasty is associated with significant peri-operative blood loss. Various studies have shown that the use of tranexamic acid reduces post-operative blood loss and need for allogeneic blood transfusion in total knee arthroplasty.
Objectives: To assess the effect of tranexamic acid in the reduction of the postoperative blood loss in total knee arthroplasty.
Methodology: An analytical cross-sectional study was carried out in 14 patients who underwent primary total knee arthroplasty during the study period of 12 months at Kathmandu Medical College. Seven patients were allocated to the case group and received one gram (gm) of tranexamic acid thirty minutes prior to the incision and five hundred milligram (mg) orally three times a day till the drain was removed. Tranexamic acid was not given to the seven patients in control group. The haemoglobin of the patient was recorded on the day of surgery and the total amount of drain output was recorded on postoperative period until the drain was removed.
Results: Out of 14 patients operated, it was found that the average amount of drain in the patients in case group was 628 ± 234 millilitre (ml) which was significantly lower than the control group 1028 ± 183 ml (p<0.05). Though there was difference in the amount of drain output, there was no significant change in the postoperative haemoglobin level in both
the groups (p = 0.381).
Conclusion: Tranexamic acid, an antifibrinolytic agent, can be effective to reduce blood loss in patients who undergo major surgeries like total knee arthroplasty.
Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemela HM, Mantyla SK, Kuisma RP, Ylinen JE. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg. 1997 Apr;84(4):839-44. [PubMed| Full Text]
Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003 May;90(5):596-9. [PubMed| DOI |Full Text]
Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br. 2005 Nov;87(11):1480-2. [PubMed |Full Text]
Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br. 1996 May;78(3):434-40. [Full Text]
Mylod Jr AG, France MP, Muser DE, Parsons JR. Perioperative blood loss associated with total knee arthroplasty. A comparison of procedures performed with and without cementing. J Bone Joint Surg Am. 1990 Aug 1;72(7):1010-2.[Full Text]
Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2011 Jul 1;19(7):1121-30.[PubMed |DOI]
Klenerman L, Chakrabarti R, Mackie I, Brozovic M, Stirling Y. Changes in hæmostatic system after application of a tourniquet. Lancet. 1977;970-2. [DOI |Full Text]
Nakahara M, Sakahashi H. Effect of application of a tourniquet on bleeding factors in dogs. J Bone Joint Surg Am. 1967 Oct;49(7):1345-51 [Full Text]
Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology. 2006 Nov;105(5):1034-46. [Full Text]
Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion. 2005 Aug;45(8):1302-7. [Full Text]
Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W. Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res. 2009 Mar;123(5):687- 96. [Full Text]
Hoylaerts M, Lijnen HR, Collen D. Studies on the mechanism of the antifibrinolytic action of tranexamic acid. Biochim Biophys Acta. 1981 Feb 18;673(1):75-85.[PubMed]
Hardy JF, Bélisle S. Natural and synthetic antifibrinolytics in adult cardiac surgery: efficacy, effectiveness and efficiency. Can J Anaesth. 1994 Nov;41(11):1104-12. [PubMed |Full Text]
Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. Bmj. 2012 May 20;344. [Full Text]
Seol YJ, Seon JK, Lee SH, Jin C, Prakash J, Park YJ, et al. Effect of tranexamic acid on blood loss and blood transfusion reduction after total knee arthroplasty. Knee Surg Relat Res. 2016 Sep;28(3):188-93. [PubMed | Full Text | DOI]
Hari Krishnan B, Pushkar A, Vikas R. A study of efficacy of tranexamic acid in reduction of blood loss in primary total knee arthroplasty. Int J Res Orthop. 2018;4(2):309. [Full Text]
Molloy DO, Archbold HAP, Ogonda L, McConway J, Wilson RK, Beverland DE. Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement. J Bone Joint Surg Br. 2007;89-B(3):306–9.[Full Text]
Sreehari C, Nithin S, Shenoy M, Shareef A. Tranexamic acid - cost effective method in preventing blood loss in total knee replacement. Int J Adv Med. 2014;1(3):196. [Full Text]
Shinde A, Sobti A, Maniar S, Mishra A, Gite R, Shetty V. Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population. Asian J Transfus Sci. 2015 JulDec;9(2):168-72. [Full Text]