Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery.
OBJECTIVE
To evaluate the effect of locally applied tranexamic acid on postoperative blood loss and measures of fibrinolysis in drained blood.


METHODS
Prospective study.


METHODS
University hospital, Norway.


METHODS
30 patients operated on for low back pain by screw fixation of the lumbar spine, 16 of who were randomised to be given topical tranexamic acid.


METHODS
Postoperative blood loss after 18 hours. Concentrations of plasmin/alpha2-antiplasmin (PAP) and D-dimer in arterial and drained blood at the time of wound closure and in drained blood after 1 hour.


RESULTS
In the tranexamic group median (interquartile) blood loss was reduced by half from 525 (325-750) ml to 252 (127-465) ml, p = 0.02. In drained blood after one hour the increase in the concentration of PAP was 150 (109-170)% and D-dimer 150 (107-272)% in the tranexamic group compared with the control group where the increase in PAP was 320 (140-540)% and D-dimer 260 (161-670)%.


CONCLUSIONS
Tranexamic acid applied in the wound inhibits blood loss by up to a half in major orthopaedic surgery probably because it prevents excessive fibrinolysis.
Krohn
Claus Danckert
CD
Department of Anaesthesiology, Centre for Orthopaedics, Rikshospitalet, University of Oslo, Oslo, Norway. danckert.krohn@rikshospitalet.no
Sørensen
Roger
R
Lange
Johan Emil
JE
Riise
Rolf
R
Bjørnsen
Stine
S
Brosstad
Frank
F
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005341:Fibrinolysin / Q000032:analysis; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D013123:Spinal Fusion; D007507:Therapeutic Irrigation; D014148:Tranexamic Acid / Q000008:administration & dosage*; D000979:alpha-2-Antiplasmin / Q000032:analysis
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; D000979:alpha-2-Antiplasmin; C036309:fibrin fragment D; D014148:Tranexamic Acid; D005341:Fibrinolysin