Title: Comparative Study of Reducing Blood Loss in Total Knee Replacement with and without the Use of Tranexamic Acid, Tourniquet, and Drainage
Authors: Mustafa M Elfadli, Hassan A Bushaala, Ayman B Alhowty, Tareq Diryaq, Hatem Eltawahny, Seraj Elzentani
DOI: https://dx.doi.org/10.18535/jmscr/v12i07.01
Abstract
Background: Patients who undergo total knee arthroplasty (TKA) may develop large blood loss. The intraoperative and postoperative blood loss after TKA ranges from 1500 to 1900 cc. TKA is often carried out using a tourniquet and drains to collect the shedded blood loss. However, tranexamic acid is found to decrease blood loss. Tranexamic acid is a fibrinolysis inhibitor that blocks the plasminogen, and it has been reported before that it reduces blood loss in patients undergoing TKA. However, few reports describe the effects of tranexamic acid on blood loss in patients who underwent TKA.
Objectives: To study the reduction of blood loss after intravenous tranexamic acid infusion in patients undergoing TKA without the use of tourniquets or drains.
Patients and Methods: We performed a total of 95 TKA in osteoarthritis patients between 2017-2018. A total of 30 patients were operated during 2017 and at that time tourniquets with drains were used with no intravenous tranexamic acid. On the other hand, a total of 45 patients were operated in the year 2018 and for those intravenous tranexamic acid was used to decrease the blood loss without the use of tourniquets or drains. For those who received tranexamic acid it was given as follows, at time of anesthesia induction a total of 1 gram tranexamic acid is infused over 10 min. At closure, another 1 gram tranexamic acid is infused over 10 min. Furthermore, Patient's demographics, preoperative and postoperative hemoglobin (Hb) levels were studied as well as the need for blood transfusion between the two groups.
Results: The two groups had similar characteristics. The mean of pre and postoperative hemoglobin difference was 2.9 (SD 1.0) and 3.5 (SD 1.23) in the tourniquets and tranexamic acid groups respectively (p value = 0.041). However, postoperatively 5 (16.6%) of the tourniquets group received blood transfusion. Whereas, no one (0%) of the tranexamic acid patients needed to receive blood (p value = 0.005).
Conclusion: The use of tranexamic acid may decrease the total blood loss in patients undergoing TKA. Furthermore, there is less need for blood transfusion in those who received tranexamic acid.
