title: Does a single loading dose of tranexamic acid reduce perioperative blood loss and transfusion requirements after total knee replacement surgery? A randomized, controlled trial.
abstract: BACKGROUND
  Total knee replacement (TKR) is associated with high-perioperative blood loss, which often requires allogenic blood transfusion. Among the many strategies to decrease the need for allogenic transfusion, tranexamic acid (TA) is used systemically in perioperative setting with promising outcome. Here we evaluated the efficacy of single preoperative bolus dose of TA on reduction in blood loss and red blood cell transfusion in patients undergoing unilateral TKR.
  
  
  METHODS
  70, American Society of Anesthesiologists I-II patients scheduled for unilateral TKR were included. Patients were randomly allocated into two groups to receive either TA (Group-TA; 20 mg/kg diluted to 25 cc with normal saline) or an equivalent volume of normal saline (Group P). Hemoglobin concentration, packed cell volume, platelet count, fibrinogen level, D-dimer level was measured preoperatively and at 6(th) and 24(th) h postoperative period.
  
  
  RESULTS
  In Group P more blood, colloid and crystalloid solutions were used to replace the blood loss. 27 patients in Group TA did not require transfusion of any blood products compared to 6 patients in Group P (P < 0.0001) and only 3 units of blood was transfused in Group TA where as a total of 32 units of blood was transfused in Group P. Despite the more numerous transfusions, Hb% after 6 h and 24 h in Group P were considerably low in comparison with Group TA (P < 0.0001).
  
  
  CONCLUSIONS
  Tranexamic acid while significantly reducing blood loss caused by TKR surgery collaterally reduced the need for postoperative blood transfusion.
authors: Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Bankura, India.
authors: Ratul
authors: R
authors: Kundu
authors: Department of Anaesthesiology, College of Med and Sagore Dutta Hospital, Bankura, India.
authors: Anjan
authors: A
authors: Das
authors: Department of Anaesthesiology, College of Med and Sagore Dutta Hospital, Bankura, India.
authors: Sandip Roy
authors: SR
authors: Basunia
authors: Department of Anaesthesiology, College of Med and Sagore Dutta Hospital, Bankura, India.
authors: Tapas
authors: T
authors: Bhattacharyya
authors: Department of Anaesthesiology, Bankura Sammilani Medical College, Bankura, India.
authors: Surajit
authors: S
authors: Chattopadhyay
authors: Department of Anaesthesiology, N. R. S Medical College and Hospital, Kolkata, West Bengal, India.
authors: Anindya
authors: A
authors: Mukherjee
keywords: Blood loss; total knee replacement; tranexamic acid