title: Optimizing effectivity of tranexamic acid in bilateral knee arthroplasty - A prospective randomized controlled study.
abstract: BACKGROUND
  Tranexamic acid (TEA) is used in reducing surgical blood loss. Literature shows no optimal regimen recommended for Bilateral Total Knee Arthroplasty (TKA). We evaluated three TEA regimens differing in dosage, timing and mode of administration in bilateral TKA to identify the most effective regimen to reduce blood loss.
  
  
  METHODS
  We prospectively studied three TEA regimens (25 patients each) as follows: (1) two intraoperative, intravenous doses (IOIO), (2) two intraoperative local applications (LALA), and (3) one preoperative plus two intraoperative, intravenous doses (POIOIO). Two independent parameters of drain loss and total blood loss, calculated by the hemoglobin balance method were statistically evaluated.
  
  
  RESULTS
  Mean drain loss was least (412.9ml) in the POIOIO group, greatest (607.2ml) in the IOIO group and LALA group in between (579.4ml), with a statistically significant difference among them (p=0.0022). On paired evaluation, the drain loss in the POIOIO group was significantly less as compared to the other two groups, whereas the difference between IOIO and LALA was not significant. Mean total blood loss was least in the POIOIO group (1207ml) and greatest in LALA group (1270ml). The difference among the groups was not statistically significant (p=0.80). There was no incidence of any thromboembolic phenomenon. On correlation with our study on Most Effective Regimen in Unilateral TKA, both results were found to substantiate each other.
authors.affiliation: Lilavati Hospital, A-791, Bandra Reclamation, Bandra (W), Mumbai Pin-400050, India. Electronic address: drmaniar@jointspeciality.com.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Maniar
authors.affiliation: Department of Orthopedics, Padamshree D Y Patil Medical College, Sector 7, Nerul, Navi Mumbai 400706, India. Electronic address: tusharsinghi@hotmail.com.
authors.forename: Tushar
authors.initials: T
authors.lastname: Singhi
authors.affiliation: Orthopaedic Department, Bharati Vidyapeeth Deemed University, Medical College and Hospital, Pune 4111043, India. Electronic address: draniketpatil12@gmail.com.
authors.forename: Aniket
authors.initials: A
authors.lastname: Patil
authors.affiliation: Jhansi Orthopedic Hospital, Jhansi 284128, Uttar Pradesh, India. Electronic address: gauravkumarh14@hotmail.com.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Kumar
authors.affiliation: 51-B, Nook Apartment, S.V. Road, North Avenue Junction, Santacruz (W), Mumbai Pin-400054, India. Electronic address: parulmaniar@hotmail.com.
authors.forename: Parul
authors.initials: P
authors.lastname: Maniar
authors.affiliation: Agrawal Ramakrishna Care Hospital, Raipur, Chattisgarh 492001, India. Electronic address: jai.ortho@gmail.com.
authors.forename: Jaivardhan
authors.initials: J
authors.lastname: Singh
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Bilateral knee arthroplasty; Blood conservation; Regimen; Tranexamic acid