Acta Chir Orthop Traumatol Cech. 2015; 82(6):418-423 | DOI: 10.55095/achot2015/069

The Effect of Tranexamic Acid on Blood Loss after Primary Unilateral Total Knee Arthroplasty. Prospective Single-Centre StudyOriginal papers

J. PERTLÍČEK1,*, J. STEHLÍK1, P. SADOVSKÝ1, D. MUSIL1, V. MEZERA2
1 Ortopedické oddělení, Nemocnice České Budějovice
2 Ústav fyziologie, Lékařská fakulta Univerzity Karlovy v Hradci Králové

PURPOSE OF THE STUDY:
Tranexamic acid is an antifibrinolytic agent which blocks plasmin-mediated fibrin degradation. It is used in surgery to reduce intra-operative and post-operative blood loss. The aim of our study was to assess the effect of tranexamic acid administration on blood loss after elective primary unilateral total knee arthroplasty.

MATERIAL AND METHODS:
A total of 119 patients (50 men, 69 women) with an average age of 69.2 years were included. The patients were randomised into two groups: Group A received a single dose of tranexamic acid (Exacyl, 1.5 g i.v.) before the operation; Group B (control) did not receive any antifibrinolytic agent. All patients underwent surgery under spinal anaesthesia with a tourniquet applied to the operated leg. The intra-operative blood loss, post-operative blood loss based on drainage, pre- and post-operative levels of haemoglobin and haematocrit, and the number of administered blood transfusions were analysed.

RESULTS:
The administration of tranexamic acid led to a reduction in post-operative blood loss at all intervals tested, including the total blood loss (504 ± 214 vs 815 ± 231 ml; p < 0.001), and to reduced requirements for blood transfusion (1.18 ± 0.51 vs 1.54 ± 0.84 transfusion units; p < 0.05). A similar effect was observed in the subgroups of men and women; the total blood loss was higher in men than in women in both group B (non-significant) and group A (p < 0.05) patients. There was a gradual decline in haemoglobin and haematocrit levels during the post-operative period, with no significant differences between the two groups. Nor were there any differences in intra-operative blood losses either. No severe complications such as stroke, acute myocardial infarction or thromboembolic disease were recorded.

DISCUSSION:
The administration of tranexamic acid before the application of a tourniquet resulted in reducing post-operative, but not intra-operative, blood losses in patients undergoing elective total knee arthroplasty. Transfusion requirements were reduced as well.

CONCLUSIONS:
Our study confirmed the efficacy and safety of tranexamic acid administration in relation to blood loss after total knee arthroplasty. In this indication, the administration is in accordance with the literature data.

Keywords: tranexamic acid, total knee arthroplasty, post-operative haemorrhage, haemoglobin

Published: December 1, 2015  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
PERTLÍČEK J, STEHLÍK J, SADOVSKÝ P, MUSIL D, MEZERA V. The Effect of Tranexamic Acid on Blood Loss after Primary Unilateral Total Knee Arthroplasty. Prospective Single-Centre Study. Acta Chir Orthop Traumatol Cech. 2015;82(6):418-423. doi: 10.55095/achot2015/069. PubMed PMID: 26787182.
Download citation

References

  1. BENONI, G., FREDIN, H.: Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J. Bone Jt Surg., 78-B: 434-440, 1996. Go to original source...
  2. BENONI, G., LETHAGEN, S., FREDIN, H.: The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty. Thromb. Res., 85: 195-206, 1997. Go to original source... Go to PubMed...
  3. BENONI, G., LETHAGEN, S., NILSSON, P., FREDIN, H.: Tranexamic acid, given at the end of the operation, does not reduce postoperative blood loss in hip arthroplasty. Acta Orthop. Scand., 71: 250-254, 2000. Go to original source... Go to PubMed...
  4. BENONI, G., FREDIN, H., KNEBEL, R., NILSSON, P.: Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop. Scand., 72: 442-448, 2001. Go to original source... Go to PubMed...
  5. BIDOLEGUI, F., ARCE, G., LUGONES, A., PEREIRA, S., VINDVER, G.: Tranexamic Acid Reduces Blood Loss and Transfusion in Patients Undergoing Total Knee Arthroplasty without Tourniquet: A Prospective Randomized Controlled Trial. Open Orthop. J., 8: 250-254, 2014. Go to original source... Go to PubMed...
  6. CASATI, V., GUZZON, D., OPPIZZI, M., COSSOLINI, M., TORRI, G., CALORI, G., ALFIERI, O.: Hemostatic effects of aprotinin, tranexamic acid and epsilon-aminocaproic acid in primary cardiac surgery. Ann. Thorac. Surg., 68: 2252-2256; discussion 2256-2257, 1999. Go to original source... Go to PubMed...
  7. CASATI, V., GUZZON, D., OPPIZZI, M., BELLOTI, F., FRANCO, A., GERLI, C., COSSOLINI, M., TORRI, G., CALORI, G., BENUSSI, S., ALFIERI, O.: Tranexamic acid compared with high-dose aprotinin in primary elective heart operations: effects on perioperative bleeding and allogeneic transfusions. J. Thorac Cardiovasc Surg., 120: 520-527, 2000. Go to original source... Go to PubMed...
  8. CLAEYS, M.A., VERMEERSCH, N., HAENTJENS, P.: Reduction of blood loss with tranexamic acid in primary total hip replacement surgery. Acta Chir. Belg., 107: 397-401, 2007. Go to original source... Go to PubMed...
  9. DIETRICH, W., SPANNAGL, M., BOEHM, J., HAUNER, K., BRAUN, S., SCHUSTER, T., BUSLEY, R.: Tranexamic acid and aprotinin in primary cardiac operations: an analysis of 220 cardiac surgical patients treated with tranexamic acid or aprotinin. Anesth. Analg., 107: 1469-1478, 2008. Go to original source... Go to PubMed...
  10. DUNN, C.J., GOA, K.L.. Tranexamic acid: a review of its use in surgery and other indications. Drugs 57: 1005-1032, 1999. Go to original source... Go to PubMed...
  11. FAHMY, N.R., PATEL, D.G.: Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet. J. Bone Jt Surg., 63-A: 461-465, 1981. Go to original source...
  12. FERGUSSON, D.A., HEBERT, P.C., MAZER, C.D., FREMES, S., MACADAMS, C., MURKIN, J.M., TEOH, K., DUKE, P.C., ARELLANO, R., BLAJCHMAN, M.A., BUSSIÈRES, J.S., CÔTÉ, D., KARSKI, J., MARTINEAU, R., ROBBLEE, J.A., RODGER, M., WELLS, G., CLINCH, J., PRETORIUS, R., BART Investigators: A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N. Engl. J. Med., 358: 2319-2331, 2008. Go to original source... Go to PubMed...
  13. GANDHI, R., EVANS, H.M., MAHOMED, S.R., MAHOMED, N.N.: Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis. BMC Res. Notes, 6: 184, 2013. Go to original source... Go to PubMed...
  14. CHAROENCHOLVANICH, K., SIRIWATTANASAKUL, P.: Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin. Orthop. Relat. Res., 469: 2874-2880, 2011. Go to original source... Go to PubMed...
  15. IRISSON, E., HEMON, Y., PAULY, V., PARRATTE, S., ARGENSON, J.N., KERBAUL, F.: Tranexamic acid reduces blood loss and financial cost in primary total hip and knee replacement surgery. Orthop. Traumatol. Surg. Res., 98: 477-483, 2012. Go to original source... Go to PubMed...
  16. LOSTAK, J., GALO, J., MlCUCHOVA, D.: [Multivariate analysis of blood loss during primary total hip or knee arthroplasty]. Acta Chir. orthop. Traum. čech., 80: 219-225, 2013. Go to original source...
  17. MCCORMACK, P.L.. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs, 72: 585-617, 2012. Go to original source... Go to PubMed...
  18. PATEL, J.N., SPANYER, J.M., SMITH, L.S., HUANG, J., YAKKANTI, M.R., MALKANI, A.L.: Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J. Arthroplasty, 29: 1528-1531, 2014. Go to original source... Go to PubMed...
  19. POLEDNIK, Z., PASTUCHA, M.: Užití turniketu u primoimplantací totálních náhrad kolenního kloubu. Jsou nižší krevní ztráty při užití turniketu "evidence-based", či zažitou fikcí? Ortopedie, 8: 137-140, 2014.
  20. RAJESPARAN K, BIANT, L.C., AHMAD, M., FIELD, R.E.: The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J. Bone Jt Surg., 91-B: 776-783, 2009. Go to original source... Go to PubMed...
  21. SALIDO JA, MARIN, L.A., GOMEZ, L.A., ZORRILLA, P., MARTINEZ, C.: Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J. Bone Jt Surg., 84-A: 216-220, 2002. Go to original source... Go to PubMed...
  22. SHARROCK, N.E., GO, G., SCULCO, T.P., RANAWAT, C.S., MAYNARD, M.J., HARPEL, P.C.: Changes in circulatory indices of thrombosis and fibrinolysis during total knee arthroplasty performed under tourniquet. J. Arthroplasty, 10: 523-528, 1995. Go to original source... Go to PubMed...
  23. SIBONI, S.M., BIGUZZI, E., PASTA, G., MANNUCCI, P.M., MISTRETTA, C., FANTINI, N.N., SOLIMENO, L.P., PEYVANDI, F.: Management of orthopaedic surgery in rare bleeding disorders. Haemophilia, 20: 693-701, 2014. Go to original source... Go to PubMed...
  24. STEHLIK, J., MUSIL, D., HELD, M., STAREK, M.: [Z-plasty for valgus deformity in total knee arthroplasty]. Acta Chir. orthop. Traum. čech., 73: 169-175, 2006. Go to original source...
  25. SÚKL. EXACYL - SPC (souhrn údajů o přípravku). 2014.
  26. TETRO, A.M., RUDAN, J.F.: The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can. J. Surg., 44: 33-38, 2001.
  27. YEN, S.H., LIN, P.C., KUO, F.C., WANG, J.W.: Thromboprophylaxis after minimally invasive total knee arthroplasty: a comparison of rivaroxaban and enoxaparin. Biomed. J., 37: 199-204, 2014. Go to original source... Go to PubMed...