title: Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients.
abstract: BACKGROUND
  The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen.
  
  
  OBJECTIVE
  We studied different dosages, timings, and modes of administration to identify the most effective regimen of tranexamic acid in achieving maximum reduction of blood loss in TKA.
  
  
  METHODS
  We prospectively studied five regimens (four intravenous, one local; 40 patients each) with a control group (no tranexamic acid). The four intravenous (10-mg/kg dose) regimens included (1) intraoperative dose (IO) given before tourniquet deflation, (2) additional preoperative dose (POIO), (3) additional postoperative dose (IOPO), and (4) all three doses (POIOPO). The fifth regimen was a single local application (LA). Two independent parameters of drain loss and total blood loss, calculated by the hemoglobin balance method, were evaluated statistically.
  
  
  RESULTS
  Both parameters were reduced in all five regimens as against the control. A significant reduction in drain loss was seen in the POIO, IOPO, and POIOPO groups whereas total blood loss was significantly reduced in the POIO, POIOPO, and LA groups. The POIOPO group had the least drain loss (303 mL) and least total blood loss (688 mL). The IO group had the greatest drain loss and the IOPO group the greatest total blood loss.
  
  
  CONCLUSIONS
  Single-dose tranexamic acid did not give effective results. The two-dose regimen of POIO was the least amount necessary for effective results. When compared against the control, this regimen produced reduction of drain loss and total blood loss, whereas the IOPO regimen did not. The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss.
authors.affiliation: Department of Orthopaedic Surgery, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra (W), Mumbai 400050, India. drmaniar@jointspeciality.com
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Maniar
authors.forename: Gaurav
authors.initials: G
authors.lastname: Kumar
authors.forename: Tushar
authors.initials: T
authors.lastname: Singhi
authors.forename: Ravi Mohan
authors.initials: RM
authors.lastname: Nayak
authors.forename: Parul R
authors.initials: PR
authors.lastname: Maniar
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007194:India; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors; D014111:Tourniquets; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D015415:Biomarkers; D006454:Hemoglobins; D014148:Tranexamic Acid