Effect of tranexamic acid on blood loss and transfusion requirement in total knee replacement in the Indian population: A case series.
BACKGROUND
Total knee replacement (TKR) is often carried out using a tourniquet to minimize intraoperative blood loss. However, its application enhances local fibrinolysis, resulting in excessive blood loss during the post-operative period. Fibrinolytic profile varies in different regions and races. Tranexamic acid has been shown to reduce post-operative blood loss and the need for transfusion in TKR. However, there is paucity of literature from the Indian population and the efficacy of the agent has not been tested in Indian patients undergoing TKR.


OBJECTIVE
Effect of tranexamic acid on blood loss in TKR surgery in the Indian population.


METHODS
In this double-blinded study, 40 patients undergoing unilateral TKR were randomly divided into two groups.


METHODS
All patients were conducted under spinal anaesthesia using injection bupivacaine 0.5% heavy 12-15 mg. The treatment group received 10 mg/kg tranexamic acid, intravenous (IV), half an hour before deflation of the tourniquet, with a second dose of 2 mg/kg administered 3 hours after the first dose. The exact protocol was followed for the placebo group, except that normal saline was used instead of tranexamic acid. Blood loss, blood transfusion details and change in haemoglobin levels were noted.


METHODS
Student's paired 't' test was used in statistical analysis.


RESULTS
The mean post-operative blood loss in the tranexamic acid group was 272.5±122.5 ml (mean±SD), and 685±118.2 ml in the placebo group (P<0.001). The total blood loss was lower in the tranexamic acid group than in the placebo group (427.6 ml vs. 911.6 ml; P<0.001). The absolute number of blood transfusions and the number of patients who required transfusions were lower in the tranexamic acid group than in the placebo group. None of the patients had any side or adverse effect.


CONCLUSIONS
Tranexamic acid significantly decreases post-operative blood loss and reduces the need for blood transfusion in patients undergoing TKR.
Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Parshotam Lal
PL
Gautam
Sunil
S
Katyal
Mohammad
M
Yamin
Amandip
A
Singh