Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610-patient consecutive case series.
BACKGROUND
Tranexamic acid (TXA) has been reported to demonstrate efficacy in reducing blood loss during arthroplasty procedures.


METHODS
This study examines the effectiveness of TXA as a central element of a patient blood management program (PBMP) by evaluating blood loss and transfusion of red blood cells in three consecutive groups of patients undergoing routine total knee arthroplasty (TKA). Approximately 200 patients were in each group as follows: Group 1 was a control without TXA, Group 2 was intraarticular administration, and Group 3 was intravenous (IV) administration.


RESULTS
The IV group demonstrated a small but significant lower blood loss compared to the two other groups measured by hemoglobin (Hb) drift and nadir Hb levels. The routine use of TXA along with the other aspects of our PBMP provided significant cost savings due to the reduction in transfusions as well as a decrease in length of stay and has been an important element of our successful implementation of a PBMP.


CONCLUSIONS
This study demonstrates a significant benefit from the routine use of TXA for total knee arthroplasty and is one of the first studies to demonstrate a small but significant benefit for IV administration in comparison to intraarticular administration. The routine use of TXA as a central element of a PBMP provides a cost savings and can help reduce the rate of transfusions for total knee arthroplasty.
Department of Orthopedic Surgery, Medstar Georgetown University Hospital, Washington, DC.
Michael
M
Pitta
Department of Orthopedic Surgery, Medstar Georgetown University Hospital, Washington, DC.
Mark
M
Zawadsky
Department of Bloodless Medicine & Surgery, Medstar Georgetown University Hospital, Washington, DC.
Richard
R
Verstraete
Department of Orthopedic Surgery, Medstar Georgetown University Hospital, Washington, DC.
Aaron
A
Rubinstein
D061605:Administration, Intravenous; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage*
D014148:Tranexamic Acid