Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied.
BACKGROUND
In total knee arthroplasty surgery, a blood conservation program is applied as a normal clinical practice to avoid allogenic transfusions. The objective of this study was to assess the effectiveness of tranexamic acid to reduce transfusions in total knee replacement even when a blood conservation program is applied.


METHODS
In a double-blind prospective study the patients scheduled for total knee arthroplasty were included in a well-established blood conservation program and then randomly assigned into two groups: In tranexamic acid group, 10 mg per kg ev bolus followed by 1 mg per kg per hour perfusion was administered, while in the control group, saline was given matching the protocol.


RESULTS
Ninety-five patients were included (tranexamic acid group, 46; control group, 49). Thirty-three patients (34.7%) underwent preoperative procedures to reduce transfusions: presurgical autologous blood donation (12), recombinant erythropoietin (6), and elementary iron (15); postoperative drain for reinfusion was allocated in all the cases. Total blood loss on the fourth postoperative day was [mean (+/-SD)] 1744 (+/-804) mL in controls compared with 1301 (+/-621) mL in the tranexamic acid group (p < 0.05). Eleven units of blood were transfused (6 patients) in the control group versus one in the tranexamic acid group (p < 0.05). Only 2 patients (4%) in the tranexamic acid group received reinfusion of blood recovered by drains compared with 36 (73%) in the control group (p < 0.0001). No thromboembolic complications were detected.


CONCLUSIONS
Tranexamic acid reduces blood losses and transfusion requirements even when a blood conservation program was used and it questions the usefulness of the postoperative reinfusion drains.
Alvarez
Juan C
JC
Department of Anesthesiology, University Hospital of Mar, Barcelona, Spain. 94188@imas.imim.es
Santiveri
Francisco X
FX
Ramos
Isabel
I
Vela
Enrique
E
Puig
Lluis
L
Escolano
Fernando
F
D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D004311:Double-Blind Method; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid