Publication:

A study of efficacy of tranexamic acid in reduction of blood loss in primary total knee arthroplasty

Background Tranexamic acid (TXA) has been shown to be effective in reducing blood loss during trauma and surgeries. Although there is no well-established protocol, it is now increasingly being used in joint replacement surgeries. The present study was designed to study the effect of intravenously given tranexamic acid during primary total knee replacement in reducing intraoperative blood loss and need for blood transfusion requirement, compared to a placebo.

Methods This study was designed as a parallel arm, double blind trial. 100 patients of primary osteoarthritis undergoing total knee arthroplasty under tourniquet was included in the study. The efficacy of a single preoperative bolus of TXA in the dose of 15 mg/kg on perioperative blood losses was studied against a placebo with objectives to compare the pre- and 24-hours post-operative level of haemoglobin (Hb) and haematocrit (Hct) levels and assess total volume of blood loss till 24-hours postoperatively and need for blood transfusion.

Results Out of 168 patients, who underwent TKA in our centre during the period of the study, 100 were included in the study, 50 patients were included in placebo group and 50 patients were included in TXA group. There was a statistically significant reduction in the use of transfusion (Fisher exact test; P=0.001). A total of 46 units of blood were used; 42 units transfused to participants in the placebo group and only 4 units transfused to participants in the TXA group.

Conclusions Intravenous TXA in primary arthroplasty leads to a statistically significant reduction in total blood loss and requirement for allogeneic blood transfusion with no apparent increased risk of thrombo-embolic complications.