title: Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty.
abstract: The application of a pneumatic tourniquet in orthopedic procedures enhances local fibrinolysis. Consequently, a short-term antifibrinolytic therapy may be indicated in this clinical situation to reduce postoperative blood loss. The purpose of this prospective double-blind study was to investigate the effect of tranexamic acid (TA) on blood loss associated with total knee arthroplasty (TKA). Seventy-five patients scheduled for 77 TKAs were randomized to receive either TA (n = 39) or equal volume of normal saline (NS, n = 38). Before deflation of the tourniquet, 15 mg/kg of TA was given intravenously followed by two 10-mg/kg additional doses. Perioperative blood loss gathered in surgical gauzes, suction reservoirs, and postoperative drainage system was measured. The number of transfusions given during hospitalization was registered. Total blood loss (mean +/- SD) was 689 +/- 289 mL in the TA group and 1509 +/- 643 mL in the NS group (P < 0.0001). The mean number of transfused red cell units in the TA group was 1.0 +/- 1.2 compared to 3.1 +/- 1.6 in the NS group (P < 0.0001). Twenty-two patients in the TA group and four patients in the NS group were treated without transfusion (P < 0.00003). Two patients in the TA group and three in the NS group had a deep venous thrombosis, including a fatal case of pulmonary embolism in the NS group. We conclude that short-term TA therapy significantly reduces TKA-associated blood loss and transfusion requirements without increasing thromboembolic complications.
authors.affiliation: Department of Anesthesia, South Carelian Central Hospital, Lappeenranta, Finland.
authors.forename: S T
authors.initials: ST
authors.lastname: Hiippala
authors.forename: L J
authors.initials: LJ
authors.lastname: Strid
authors.forename: M I
authors.initials: MI
authors.lastname: Wennerstrand
authors.forename: J V
authors.initials: JV
authors.lastname: Arvela
authors.forename: H M
authors.initials: HM
authors.lastname: Niemelä
authors.forename: S K
authors.initials: SK
authors.lastname: Mäntylä
authors.forename: R P
authors.initials: RP
authors.lastname: Kuisma
authors.forename: J E
authors.initials: JE
authors.lastname: Ylinen
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D011446:Prospective Studies; D013924:Thrombophlebitis / Q000209:etiology; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid