A Comparison Study between 1 gram and 2 grams of Tranexamic Acid for Reducing Blood Loss and Transfusion Requirements in Total Knee Arthroplasty
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Published:
Apr 30, 2021
Keywords:
Tranexamic acid Total Knee Arthroplasty
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Abstract
Objective: To compare the effectiveness between 1 g and 2 g of tranexamic acid on blood loss and packed red cell transfusion requirements in total knee arthroplasty (TKA) in Thai patients.
Methods: This study evaluates the use of TXA in 50 TKA performed in a single surgeon at Priest Hospital between 2014 and 2020. The initial 25 patients underwent surgery with TXA 1 g (TXA1 group) while the subsequent 25 patients all received 2 g TXA (TXA2 group). Perioperative blood loss, postoperative blood loss, total blood loss, postoperative 24hr Hct, total PRC transfusion, and deep vein thrombosis (DVT) were examined.
Results: Total blood loss and postoperative blood loss were significantly higher in the TXA1 group than the TXA2 group (473.2 cc vs 290.6 cc; p-value < 0.001 and 399.6 cc vs 228.2 cc ; p-value < 0.001 respectively). Postoperative 24hr Hct were lower in the TXA1 group than the TXA2 group significantly (33.6±3.0 vs 37.0±4.4; p-value 0.002). However, the transfusion requirements were the same. None of the patients developed DVT.
Conclusion: TXA 2 g can reduce total blood loss more than TXA 1 g significantly without increasing the risk of postoperative DVT.
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References
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2. Sadeghi M, Mehr-Aein A. Does a single bolus dose of tranexamic acid reduce blood loss and transfusion requirements during hip fracture surgery? A prospective randomized double blind study in 67 patients. Acta Med Iran. 2007; 45: 437-42.
3. Mollison PL, Engelfriet CP, Contreras M. Blood transfusion in clinical medicine. 9 ed. Oxford: Blackwell; 1993.
4. Claeys MA, Vermeersch N, Haentjens P. Reduction of blood loss with tranexamic acid in primary total hip replacement surgery. Acta chir belg. 2007; 107: 397-401.
5. Jansen AJ, Andreica S, Claeys M, D'Haese J, Camu F, Jochmans K. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth. 1999; 83: 596-601.
6. 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 Joint Surg Br. 1996; 78: 434-40.
7. Sukeik M, Alshryda S, Haddad FS, Mason JM. Systematic review and meta-analysis of the use of tranexamic acid in total hip. J Bone Joint Surg Br. 2011; 93: 39-46.
8. Vanasbodeekul V. The use of tranexamic acid for reduction of blood loss in total knee and hip arthroplasty. Journal of Charoenkrung Pracharak Hospital. 2017;13:1-10.
9. Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop. 2007; 31: 39-44.
10. Borghi B, Casati A. Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. Eur J Anaesthesiol. 2000; 17: 411-7.
11. Koval KJ, Rosenberg AD, Zuckerman JD, Aharonoff GB, Skovron ML, Bernstein RL, et al. Does blood transfusion increase the risk of infection after hip fracture?. J Orthop Trauma. 1997; 11: 260-5.
12. Cohen JA, Brecher ME. Preoperative autologous blood donation: benefit or detriment? A mathematical analysis. Transfusion. 1995; 35: 640-4.
13. Sang MH, Jong HL. Perioperative blood management: Pros and Cons of ANH and cell salvage. Hanyang Med Rev. 2018; 38: 27-37.
14. Strunin L. Organ perfusion during controlled hypotension. Br J Anaesth. 1975; 47: 793-8.
15. Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth. 2004; 93: 842-58.
16. Singh J, Ballal MS, Mitchell P, Denn PG. Effects of tranexamic acid on blood loss during total hip arthroplasty. J Orthop Surg (Hong Kong). 2010; 18: 282-6.
17. Eriksson BI, Hultman E, Martinell S, Eriksson E, Tengborn L, Risberg B. Regional fibrinolysis following total hip replacement. Thromb Res. 1991; 62: 441-7.
18. Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs. 1985; 29: 236-61
19. Dunn CJ, Goa KL. Tranexamic acid: A review of its use in surgery and other indications. Drugs. 1999; 57: 1005-32.
20. Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013; 17: 1-79.
21. Ueno M, Sonohata M, Fukumori N, Kawano S, Kitajima M, Mawatari M. Comparison between topical and intravenous administration of tranexamic acid in primary total hip arthroplasty. J Orthop Sci. 2016; 21: 44-7.
22. Chen JY, Chin PL, Moo IH, Pang HN, Tay DK, Chia SL, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial. Knee. 2016; 23: 152-6.
23. North WT, Mehran N, Davis JJ, Silverton CD, Weir RM, Laker MW. Topical vs intravenous tranexamic acid in primary total hip arthroplasty: A double-blind, randomized controlled trial. J Arthroplasty. 2016; 31: 1022-6.
24. Morrison RJM, Tsang B, Fishley W, Harper I, Joseph JC, Reed MR. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty. Bone Joint Res. 2017; 6: 499-505.
25. Huang GP, Jia XF, Xiang Z, Ji Y, Wu GY, Tang Y, et al. Tranexamic acid reduces hidden blood loss in patients undergoing total knee arthroplasty: A comparative study and meta-analysis. Med Sci Monit. 2016; 10: 797-802.
26. Liu KL, Chen IH, Wen SH. Low dose tranexamic acid reduces blood transfusion rate after total knee arthroplasty: A population-based study in Taiwan. J Formos Med Assoc. 2017; 116: 24-31.
27. Mortififard M, Tahririan MA, Saneie M, Badiei S, Nemati A. Low dose perioperative intravenous tranexamic acid in patients undergoing total knee arthorplasty: A double-blind randomized placebo controlled clinical trial. J Blood Transfus. 2015; 2015: 948304.
28. Pitta M, Zawadsky M, Verstraete R, Rubinstein A. Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610-patient consecutive case series. Transfusion. 2016; 56: 466-71.
29. Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009; 91: 766-83.
2. Sadeghi M, Mehr-Aein A. Does a single bolus dose of tranexamic acid reduce blood loss and transfusion requirements during hip fracture surgery? A prospective randomized double blind study in 67 patients. Acta Med Iran. 2007; 45: 437-42.
3. Mollison PL, Engelfriet CP, Contreras M. Blood transfusion in clinical medicine. 9 ed. Oxford: Blackwell; 1993.
4. Claeys MA, Vermeersch N, Haentjens P. Reduction of blood loss with tranexamic acid in primary total hip replacement surgery. Acta chir belg. 2007; 107: 397-401.
5. Jansen AJ, Andreica S, Claeys M, D'Haese J, Camu F, Jochmans K. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth. 1999; 83: 596-601.
6. 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 Joint Surg Br. 1996; 78: 434-40.
7. Sukeik M, Alshryda S, Haddad FS, Mason JM. Systematic review and meta-analysis of the use of tranexamic acid in total hip. J Bone Joint Surg Br. 2011; 93: 39-46.
8. Vanasbodeekul V. The use of tranexamic acid for reduction of blood loss in total knee and hip arthroplasty. Journal of Charoenkrung Pracharak Hospital. 2017;13:1-10.
9. Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop. 2007; 31: 39-44.
10. Borghi B, Casati A. Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. Eur J Anaesthesiol. 2000; 17: 411-7.
11. Koval KJ, Rosenberg AD, Zuckerman JD, Aharonoff GB, Skovron ML, Bernstein RL, et al. Does blood transfusion increase the risk of infection after hip fracture?. J Orthop Trauma. 1997; 11: 260-5.
12. Cohen JA, Brecher ME. Preoperative autologous blood donation: benefit or detriment? A mathematical analysis. Transfusion. 1995; 35: 640-4.
13. Sang MH, Jong HL. Perioperative blood management: Pros and Cons of ANH and cell salvage. Hanyang Med Rev. 2018; 38: 27-37.
14. Strunin L. Organ perfusion during controlled hypotension. Br J Anaesth. 1975; 47: 793-8.
15. Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth. 2004; 93: 842-58.
16. Singh J, Ballal MS, Mitchell P, Denn PG. Effects of tranexamic acid on blood loss during total hip arthroplasty. J Orthop Surg (Hong Kong). 2010; 18: 282-6.
17. Eriksson BI, Hultman E, Martinell S, Eriksson E, Tengborn L, Risberg B. Regional fibrinolysis following total hip replacement. Thromb Res. 1991; 62: 441-7.
18. Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs. 1985; 29: 236-61
19. Dunn CJ, Goa KL. Tranexamic acid: A review of its use in surgery and other indications. Drugs. 1999; 57: 1005-32.
20. Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013; 17: 1-79.
21. Ueno M, Sonohata M, Fukumori N, Kawano S, Kitajima M, Mawatari M. Comparison between topical and intravenous administration of tranexamic acid in primary total hip arthroplasty. J Orthop Sci. 2016; 21: 44-7.
22. Chen JY, Chin PL, Moo IH, Pang HN, Tay DK, Chia SL, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial. Knee. 2016; 23: 152-6.
23. North WT, Mehran N, Davis JJ, Silverton CD, Weir RM, Laker MW. Topical vs intravenous tranexamic acid in primary total hip arthroplasty: A double-blind, randomized controlled trial. J Arthroplasty. 2016; 31: 1022-6.
24. Morrison RJM, Tsang B, Fishley W, Harper I, Joseph JC, Reed MR. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty. Bone Joint Res. 2017; 6: 499-505.
25. Huang GP, Jia XF, Xiang Z, Ji Y, Wu GY, Tang Y, et al. Tranexamic acid reduces hidden blood loss in patients undergoing total knee arthroplasty: A comparative study and meta-analysis. Med Sci Monit. 2016; 10: 797-802.
26. Liu KL, Chen IH, Wen SH. Low dose tranexamic acid reduces blood transfusion rate after total knee arthroplasty: A population-based study in Taiwan. J Formos Med Assoc. 2017; 116: 24-31.
27. Mortififard M, Tahririan MA, Saneie M, Badiei S, Nemati A. Low dose perioperative intravenous tranexamic acid in patients undergoing total knee arthorplasty: A double-blind randomized placebo controlled clinical trial. J Blood Transfus. 2015; 2015: 948304.
28. Pitta M, Zawadsky M, Verstraete R, Rubinstein A. Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610-patient consecutive case series. Transfusion. 2016; 56: 466-71.
29. Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009; 91: 766-83.