Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss.
OBJECTIVE
The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement.


METHODS
62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24h after surgery. Deep vein thrombosis was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits.


RESULTS
There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study.


CONCLUSIONS
Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.
Unidade de Ensino Médico Propedêutica Anestésico Cirúrgica da Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil; Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brazil; Clínica de Anestesiologia de Caxias do Sul (CAN), Caxias do Sul, RS, Brazil. Electronic address: danielvolquind@gmail.com.
Daniel
D
Volquind
Hospital Pompeia de Caxias do Sul, Caxias do Sul, RS, Brazil.
Remi Antônio
RA
Zardo
Hospital Pompeia de Caxias do Sul, Caxias do Sul, RS, Brazil.
Bruno Costamilan
BC
Winkler
Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
Bruno Bertagnolli
BB
Londero
Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
Natália
N
Zanelatto
Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
Gisele Perondi
GP
Leichtweis
D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006400:Hematocrit / Q000706:statistics & numerical data; D006454:Hemoglobins / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000517:prevention & control
D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid
Anestesia; Anesthesia; Bleeding; Blood transfusion; Knee prosthesis; Prótese do joelho; Sangramento; Tranexamic acid; Transfusão de sangue; Ácido tranexâmico