title: Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial.
abstract: BACKGROUND
  Recently, a number of studies using intra-articular application of tranexamic acid (IA-TXA), with different dosage and techniques, successfully reduced postoperative blood loss in total knee replacement (TKR). However, best of our knowledge, the very low dose of IA-TXA with drain clamping technique in conventional TKR has not been yet studied. This study aimed to evaluate the effectiveness and dose-response effect of two low-dose IA-TXA regimens in conventional TKR on blood loss and blood transfusion reduction.
  
  
  METHODS
  Between 2010 and 2011, a triple-blinded randomized controlled study was conducted in 135 patients undergoing conventional TKR. The patients were allocated into three groups according to intra-articular solution received: Control group (physiologic saline), TXA-250 group (TXA 250 mg), and TXA-500 group (TXA 500 mg). The solution was injected after wound closure followed by drain clamping for 2 hours. Blood loss and transfusion were recorded. Duplex ultrasound was performed. Functional outcome and complication were followed for one year.
  
  
  RESULTS
  There were forty-five patients per groups. The mean total hemoglobin loss was 2.9 g/dL in control group compared with 2.2 g/dL in both TXA groups (p > 0.001). Ten patients (22%, control), six patients (13%, TXA-250) and none (TXA-500) required transfusion (p = 0.005). Thromboembolic events were detected in 7 patients (4 controls, 1 TXA-250, and 2 TXA-500). Functional outcome was non-significant difference between groups.
  
  
  CONCLUSIONS
  Combined low-dose IA-TXA, as 500 mg, with 2-hour clamp drain is effective for reducing postoperative blood loss and transfusion in conventional TKR without significant difference in postoperative knee function or complication.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01850394.
authors.forename: Paphon
authors.initials: P
authors.lastname: Sa-Ngasoongsong
authors.forename: Siwadol
authors.initials: S
authors.lastname: Wongsak
authors.forename: Pongsthorn
authors.initials: P
authors.lastname: Chanplakorn
authors.forename: Patarawan
authors.initials: P
authors.lastname: Woratanarat
authors.forename: Supaporn
authors.initials: S
authors.lastname: Wechmongkolgorn
authors.forename: Bussanee
authors.initials: B
authors.lastname: Wibulpolprasert
authors.forename: Pornchai
authors.initials: P
authors.lastname: Mulpruek
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, Thailand10400. viroj.k2009@yahoo.com.
authors.forename: Viroj
authors.initials: V
authors.lastname: Kawinwonggowit
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001803:Blood Transfusion; D003250:Constriction; D004322:Drainage; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013785:Thailand; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid