Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a
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RESEARCH ARTICLE
Open Access
Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study Andrea L. Grant1,2, Hayley L. Letson2, Jodie L. Morris1,2, Peter McEwen1,2, Kaushik Hazratwala1,2, Matthew Wilkinson1,2 and Geoffrey P. Dobson2*
Abstract Background: Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce excessive bleeding and transfusion requirements. Our aim was to examine if TXA was required in all osteoarthritis patients undergoing TKA surgery, and its possible effects on systemic inflammation and coagulation properties. Methods: Twenty-three patients (Oxford Score 22–29) were recruited consecutively; 12 patients received TXA before (IV, 1.2 g/90 kg) and immediately after surgery (intra-articular, 1.4 g/90 kg). Inflammatory mediators and ROTEM parameters were measured in blood at baseline, after the first bone-cut, immediately after surgery, and postoperative days 1 and 2. Results: After the bone cut and surgery, TXA significantly increased MCP-1, TNF-α, IL-1β and IL-6 levels compared to non-TXA patients, which was further amplified postoperatively. During surgery, TXA significantly prolonged EXTEM clot times, indicating a thrombin-slowing effect, despite little or no change in clot amplitude or fibrinogen. TXA was associated with three- to fivefold increases in FIBTEM maximum lysis (ML), a finding counter to TXA’s antifibrinolytic effect. Maximum lysis for extrinsic and intrinsic pathways was < 8%, indicating little or no hyperfibrinolysis. No significant differences were found in postoperative hemoglobin between the two groups. Conclusions: TXA was associated with increased systemic inflammation during surgery compared to non-TXA patients, with further amplification on postoperative days 1 and 2. On the basis of little or no change in viscoelastic clot strength, fibrinogen or clot lysis, there appeared to be no clinical justification for TXA in our group of patients. Larger prospective, randomized trials are required to investigate a possible proinflammatory effect in TKA patients. Keywords: Tranexamic acid, Total knee arthroplasty, Coagulation, Inflammation, Orthopaedic surgery, Trauma
Background A common perioperative complication during knee and hip surgery is excessive bleeding and the need for blood products [1, 2]. Serine protease inhibitor aprotonin was removed from world markets in 2007 and led to renewed interest in tranexamic acid (TXA) for reducing blood loss during major surgery [3, 4]. TXA is a synthetic lysine analog that reduces active bleeding by blocking the 5 lysine-binding sites on plasminogen, * Correspondence: [email protected] 2 Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia Full list of author information is available at the end of the article
which prevents plasmin formation and decreases fibrinolysis [3, 5]. TXA has a plasma half-life of ~ 2 h, and its antifibrinoly
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