Are Three Doses of Intravenous Tranexamic Acid more Effective than Single Dose in Reducing Blood Loss During Bilateral T
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ORIGINAL ARTICLE
Are Three Doses of Intravenous Tranexamic Acid more Effective than Single Dose in Reducing Blood Loss During Bilateral Total Knee Arthroplasty? Tarun Goyal1 · Arghya Kundu Choudhury2 · Tushar Gupta2 Received: 14 May 2020 / Accepted: 8 August 2020 / Published online: 14 August 2020 © Indian Orthopaedics Association 2020
Abstract Purpose Tranexamic acid (TXA) has shown to reduce perioperative blood loss after bilateral total knee arthroplasty (TKA). But dosage and schedule of administration are not clear in literature. This study was aimed to compare prospectively blood loss and transfusion requirement in bilateral TKA with 3-dose regimen versus a single intra-operative dose of intravenous TXA. Methods This prospective non-randomised controlled trial included 25 patients undergoing bilateral simultaneous TKA who received three doses of 1 g intravenous TXA (group 1). First dose was given prior to deflation of the tourniquet, followed by two more doses 6 h apart. The control group included 25 matched patients (group 2) receiving a single dose of 1 g intravenous TXA just prior to deflation of the tourniquet. Results Mean drop in haemoglobin was less in group 1 as compared to group 2, but this difference was not statistically significant (2.51 vs 2.93 g/dL, p = 0.210). Similarly mean drop in haematocrit was more in group 2 as compared to group 1, though it was not statistically significant (9.34 vs. 9.18, p = 0.868). The need for blood transfusions was more in group 2 compared to group 1, but this difference was not statistically significant (p = 0.601). Higher frequency of ecchymosis around the surgical site was noted in group 2 as compared to group 1, for which prophylactic low-molecular-weight heparin had to be stopped post-operatively, but this difference was not statistically significant (p = 0.065). Conclusion The study has failed to show any significant beneficial effect of three doses of TXA in TKA as compared to a single dose. Though a trend towards reduction in mean haemoglobin drop and decreased need for stopping LMWH in postoperative period was seen, the results were not statistically significant. Level of Evidence II, prospective non-randomised controlled trial Keywords Total knee arthroplasty · Tranexamic acid · Blood loss · Haemoglobin · Antifibrinolytic
Introduction
* Tarun Goyal [email protected] Arghya Kundu Choudhury [email protected] Tushar Gupta [email protected] 1
Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab 151001, India
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
2
Anaemia and blood transfusion in perioperative period are associated with increased morbidity, prolonged duration of hospital stay and increased mortality [1, 2]. Interventions to reduce perioperative blood loss are an important focus for improvement in surgical practices in total knee arthroplasty (TKA). Intravenous tranexamic acid (TXA) is an evidence-based intervention to reduce blood loss
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