Prospective study to compare efficacy of systemic, local and combined administration of tranexamic acid in reducing blood loss in total knee arthroplasty

Author(s): Dr. Madhukar and Dr. Akshay Yadav D

Abstract: Perioperative blood loss is a major challenge to surgeon in TKA. There are different methods to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. 47 patients undergoing TKA were divided into three groups (IV 18 cases; IA 20 cases, and combined (IV + IA) 9 cases) corresponding to the method of TXA administration. Demographic data, preoperative hemoglobin and platelet levels were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions. Student’s t-test or a χ2 test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences. The average age of the patients was 66.2 years and there was no significant difference in demographic and preoperative haemoglobin levels. No significant differences in the outcome measures were found between intravenous and intraarticular groups, but there was a significant difference between intraarticular vs intravenous and intraarticular vs combined groups with respect to maximum hemoglobin loss, blood in drain and transfusion rates, which were more in intraarticular group. TXA administration is safe and effective in reducing total blood loss in TKA. Intravenous and combined methods seems to be better in reducing blood loss in TKA, however intraarticular has still a role to play in patients with contraindications to systemic TXA in reducing blood loss in TKA.

DOI: https://doi.org/10.22271/ortho.2018.v4.i3k.110