title: Can tranexamic acid and hydrogen peroxide reduce blood loss in cemented total knee arthroplasty?
abstract: BACKGROUND
  The use of tourniquet in total knee arthroplasty (TKA) has resulted in negligible intra-operative blood loss but notable post-operative blood loss, creating the ideal scenario for using topical haemostatic agents intra-operatively. Recently, medical adjuvants including tranexamic acid (TXA) and hydrogen peroxide (H2O2) have been introduced. The aim of this study was to evaluate the effectiveness of intra-articular TXA and H2O2 in reducing blood loss during TKA.
  
  
  METHODS
  Fifty patients, who underwent a primary TKA with 1,500 mg of intra-articular TXA between May 2011 and December 2011, were compared with two matching cohorts of 50 patients each who underwent TKA with 100 ml of 3 % H2O2 wash and TKA without any TXA or H2O2. All surgeries were performed by two senior surgeons. The total blood loss was calculated by the hemoglobin balance method.
  
  
  RESULTS
  The pre-operative serum hemoglobin levels were 13.1 ± 1.3, 13.1 ± 1.3 and 13.0 ± 1.2 g/dl (p > 0.05); while the drop in serum hemoglobin levels post-operatively was 2.0 ± 0.7, 2.4 ± 0.9 and 2.7 ± 0.8 g/dl for the TXA, H2O2 and Control groups, respectively (p < 0.001). The total amount of blood loss was 596 ± 449, 710 ± 279 and 760 ± 228 ml, respectively (p = 0.046). There was no difference in the duration of surgery between the three groups (p > 0.05).
  
  
  CONCLUSIONS
  This study showed that intra-articular TXA reduced blood loss during TKA without significantly increasing the duration of surgery. We cannot justify H2O2 wash as an alternative to intra-articular TXA to reduce blood loss during TKA.
authors: Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 169608, Singapore, yqjchen@gmail.com.
authors: Jerry Yongqiang
authors: JY
authors: Chen
authors: Inderjeet Singh
authors: IS
authors: Rikhraj
authors: Zhihong
authors: Z
authors: Zhou
authors: Darren Keng Jin
authors: DK
authors: Tay
authors: Pak Lin
authors: PL
authors: Chin
authors: Shi-Lu
authors: SL
authors: Chia
authors: Ngai Nung
authors: NN
authors: Lo
authors: Seng Jin
authors: SJ
authors: Yeo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002484:Cementation; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006861:Hydrogen Peroxide / Q000627:therapeutic use*; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D016877:Oxidants / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D014111:Tourniquets; D014148:Tranexamic Acid / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000517:prevention & control
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D016877:Oxidants; D014148:Tranexamic Acid; D006861:Hydrogen Peroxide