Details
Category: Volume 05 Issue 11 November 2017
Hits: 1514

Title: Is Intraarticular Administration of Tranexamic Acid Better than Its Intravenous Administration in Reducing Blood loss after total Knee Arthroplasty?

Authors: Dr Noorul Ameen, Dr Raja Anurag Gautam, Dr Mehamil K.V

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.38

Abstract

Context: Intravenous (IV) tranexamic acid (TXA) is a goodpotent agent in controlling postoperative blood loss following total knee arthroplasty (TKA). Recently, intraarticular usage of this agent has also shown good results. 

Aims: Comparison of postoperative blood loss between IV(intravenous) and topical administration of TXA tranexamic acid in TKAs(total knee arthroplasty) 

Materials and Design: Eighty-six TKAs on knees were included in ourstudy. Randomization was done, so that in our study 40 TKA received 1 g of IV TXA, while 46 had underwent intraarticular administration of 1 gm of TXA.

Subjects and Methods: We have compared the postoperative blood loss by calculating the difference in pre- and postop hemoglobin and the need for blood transfusion for patients .The  functional assessment was done on basis of Western Ontario McMaster Osteo-Arthritis Index (WOMAC) scores and complications like postoperative infection, oozing from  wound site and thromboembolic manifestations.

Results: The blood loss was significantly less in the intraarticular administration group as compared to the IV injection group. The total blood loss, blood transfusion, and drain output was also less but the difference was not significant. The functional assessment (WOMAC) scores were equivocal and so were the complications including thromboembolic manifestations (two cases each of deep vein thrombosis (DVT) .There was   no cases of pulmonary embolism (PE)).

Conclusion: The intraarticular administration of TXA to prevent postoperative bleeding or blood loss in TKA is a safe and effective alternative to its intravenous usage.

Keywords: Intraarticular administration, tranexamic acid, total knee arthroplasty.

References

  1. Zohar E, Ellis M, Ifrtch N, Stern A, Sapir O, Fredman B. The postoperative, blood- sparing efficacy of oral versus intravenous tranexamic acid after total knee replac-ement. Anesth Analg 2004;99:1679-83.
  2. Wong J, Abrishami A, El Beheiry H, et al. Intraarticular administration of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: A randomized, controlled trial. J Bone Joint Surg [Am] 2010;92-A: 2503-13.
  3. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM. Tranexamic acid in total knee replacement: A systema-tic review and meta-analysis. J Bone Joint Surg Br 2011;93:1577-85. [PUBMED]   
  4. Dhillon MS, Bali K, Prabhakar S. Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage. Indian J Orthop 2011;45:148-52. [PUBMED]    
  5. Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion 2008;48:519-25. [PUBMED]   
  6. Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 2011;35:1639-45.
  7. Sa-Ngasoongsong P, Channoom T, Kawinwonggowit V, Woratanarat P, Chanplakorn P, Wibulpolprasert B, et al. Postoperative blood loss reduction in computer-assisted surgery total knee replacement by low dose intra-articular tranexamic acid injection together with 2-hour clamp drain: A prospective triple-blinded randomized controlled trial. Orthop Rev (Pavia) 2011;3:e12.
  8. Roy SP, Tanki UF, Dutta A, Jain SK, Nagi ON. Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012;20:2494-501. [PUBMED]   
  9. Lozano M, Basora M, Peidro L, Merino I, Segur JM, Pereira A, et al. Effectiveness and safety of tranexamic acid adminis-tration during total knee arthroplasty. Vox Sang 2008;95:39-44. [PUBMED]   
  10. Orpen NM, Little C, Walker G, Crawfurd EJ. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: A prospective randomised controlled trial of 29 patients. Knee 2006;13:106-10.[PUBMED]
  11. Camarasa MA, Ollé G, Serra-Prat M, Martín A, Sánchez M, Ricós P, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: A randomized clinical trial. Br J Anaesth 2006;96:576-82.
  12. Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthroplasty: A prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 2012;470:2605-12. doi: 10.1007/s11999-012-2310-y. Epub 2012 Mar 15.
  13. Hiippala S, Strid L, Wennerstrand M, Arvela V, Mäntylä S, Ylinen J, et al. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth 1995;74:534-7.
  14. Shah N, Nilesh G, Patel N. Mini-subvastus approach for total knee arthroplasty in obese patients. Indian J Orthop 2010;44:292-9. [PUBMED]
  15. American Society of Anesthesiologists Task Force on Perioperative Blood Transf-usion and Adjuvant Therapies. Practice guidelines for perioperative blood transfu-sion and adjuvant therapies. Anesthe-siology 2006;105:198-208.  [PUBMED]   
  16. Veien M, Sorensen JV, Madsen F, Juelsgaard P. Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: A randomized controlled study. Acta Anaesthesiol Scand 2002;46:1206-11.
  17. Good L, Petersen E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 2003;90:596-9.
  18. Molloy DO, Archbold HA, Ogonda L, McConway J, Wilson RK, Beverland DE. Comparison of topical fibrin spray andtranexamic acid on blood loss after total knee replacement: A prospective, randomized controlled trial. J Bone Joint Surg [Br] 2007;89-B: 306-9.
  19. Zhang Y, QiRong Q, HaiShan W. A meta-analysis of tranexamic acid to reduce blood loss in total knee arthroplasty. Chinese J Orthop 2009;29:524-9.
  20. Nadler SB, Hidalgo JU, Bloch T. Prediction of blood volume in normal humanadults. Surgery 1962;51:224-32.
  21. Abrishami A, Chung F, Wong J. Intraart-icular administration of antifibrinolytic drugs for on-pump cardiac surgery: A systematic review and meta-analysis. Can J Anesth 2009;56:202-12.[PUBMED]
  22. Fawzy H, Elmistekawy E, Bonneau D, Latter D, Erret L. Can local application ofTranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial. J Cardiothoracic Surg 2009;4:25.
  23. Sindet-Pedersen S, Ramstr¨om G, Bernvil S, Blomb¨ack M. Hemostatic effect of tranexamic acid mouthwash in anticoag-ulant-treated patients undergoing oral surgery. N Engl J Med 1989;320:840-3.
  24. Benoni G, Bjorkman S, Fredin H. Application of pharmacokinetics data from healthy volunteers for the prediction of plasma concentrations of tranexamic acid in surgical patients. Clin Drug Invest 1995;10:280-7.
  25. Sano M, Hakusui H, Kojima C, Akimoto T. Absorption and excretion of tranexamic acid following intravenous, intramuscular and oral administrations in healthy volunteers. Jpn J Clin Pharmacol Therapeutics 1976;7:375-82.

Corresponding Author

Dr Noorul Ameen

Junior Resident,

Sree Balaji Medical College and Hospital Chrompet, Chennai