Efficacy of Combined Direct Intra-articular Infusion of Tranexamic Acid and Drainage Clamping in Reduction of Blood Loss after Total Knee Arthroplasty

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Natthapong Hongku
Pruk Chaiyakrit
Athaphol Sriwattana
Surapoj Meknavin


Objective: To report the results of intra-articular infusion of Tranexamic acid (TXA) combined with 4-hour drain clamping compared with 4 hours drain clamping alone for reducing blood loss in total knee arthroplasty (TKA) patients.

Methods: We retrospectively collected data of patients who underwent TKA by two surgeons in Vajira hospital from July 2013 to February 2014. Surgical approaches and perioperative management were the same in all patients. The patient’s data were divided into two groups. All patients were treated with 4-hour drain clamping as a routine measure. Group 1 was the data of patient who receiving one gram of TXA (20 ml.) intra-articularly via the drain after wound closure. Group 2 was not receiving TXA. We applied the inclusion criteria to reduce variation between groups. Data collection included pre and post-op hematocrit level, intra-op blood loss, amount of vacuum drainage on day 1 and day 2, and other important clinical data.

Results: There were 36 patients in group 1 and 39 patients in group 2. There was no statistically significantly different between groups in terms of preoperative data and operation time. Post-operative vacuum drainage of group 1 on day 1 and 2 was 148+/-71 ml. and 214+/-97 ml. while group 2 was 299+/-97 ml. and 258+/-114 respectively when compare with student’s t–test statistic. The mean amount different of drainage on day 1 was 151 ml. with statistically significant (p-value < 0.01). No patient has venous thromboembolic events upon follow up at least 3 months.

Conclusion: Intra-articular infusion of TXA combined with 4-hour drain clamping is a safe and effective method to reduce blood loss in TKA patient.


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