title: Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery.
abstract: 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.
authors.affiliation: Department of Anaesthesiology, Centre for Orthopaedics, Rikshospitalet, University of Oslo, Oslo, Norway. danckert.krohn@rikshospitalet.no
authors.forename: Claus Danckert
authors.initials: CD
authors.lastname: Krohn
authors.forename: Roger
authors.initials: R
authors.lastname: Sørensen
authors.forename: Johan Emil
authors.initials: JE
authors.lastname: Lange
authors.forename: Rolf
authors.initials: R
authors.lastname: Riise
authors.forename: Stine
authors.initials: S
authors.lastname: Bjørnsen
authors.forename: Frank
authors.initials: F
authors.lastname: Brosstad
mesh_terms: 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
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; D000979:alpha-2-Antiplasmin; C036309:fibrin fragment D; D014148:Tranexamic Acid; D005341:Fibrinolysin