Abstract:Objective To explore the perioperative efficiency and safety of different regimen of tranexamic acid (TA) in total knee arthroplasty (TKA).Methods We prospectively enrolled 187 patients operated on from April 1,2015 to January 31,2016 and randomly divided them in to two groups which were then named TA group (1 g of TA infused intravenous 20 minutes before tourniquet deflation and one dose of 1 g TA injected into articular cavity) and control group(1 g of TA infused intravenous 20 minites before tourniquet deflation andanother dose 3 hours after operation).Then we detectedthe change in blood routine,D-dimer,FDP and observe the incidence of deep venous thrombosisbetween the two groups.Results The total blood loss was less for patients in the TA group than for the control group:(619±272)mL versus (676±237)mL,respectively,there was no significant difference between the two groups(P=0.78).However,the total amount of drainage after operation in the two groups was significantly different:(171±152)mL versus (241±174)mL (P=0.023).There was no significant difference in blood transfusion rate between the two groups:9.9% versus 11.5%(P=0.23),and the incidence of DVT was similar for both groups.Conclusion Compared to two intravenous administration,tranexamic acid intravenous drip combined with local joint cavity perfusion has the same efficiency and safety,andhigher clinical operability.
[1]Moskal JT,Harris RN,Capps SG.Transfusion cost savings with tranexamic acid in primary total knee arthroplasty from 2009 to 2012[J].J Arthroplasty,2015,30(3):365-368.
[2]Wei Z,Liu M.The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty:a meta-analysis of 2720 cases[J].Transfus Med,2015,25(3):151-162.
[3]Wang H,Shen B,Zeng Y.Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty:A meta-analysis of randomized controlled and prospective cohort trials[J].Knee,2014,21(6):987-993.
[4]Sehat KR,Evans RL,Newman JH.Hidden blood loss following hip and knee arthroplasty.Correct management of blood loss should take hidden loss into account[J].J Bone Joint Surg(Br),2004,86(4):561-565.
[5]Lin SY,Chen CH,Fu YC,et al.The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty[J].J Arthroplasty,2015,30(5):776-780.
[6]赵光辉,马建兵,段虹昊,等.氨甲环酸联合给药对TKA术后失血量的有效性和安全性研究[J].实用骨科杂志,2015,21(8):691-694.
[7]Huang Z,Ma J,Shen B,et al.Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty:a prospective randomized controlled trial[J].J Arthroplasty,2014,29(12):2342-2346.
[8]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].J Bone Joint Surg(Br),1996,78(3):434-440.
[9]Lin PC,Hsu CH,Huang CC,et al.The blood-saving effect of tranexamic acid in minimally invasive total knee replacement:is an additional pre-operative injection effective?[J].J Bone Joint Surg(Br),2012,94(7):932-936.
[10]Whiting DR,Gillette BP,Duncan C,et al.Preliminary results suggest tranexamic acid is safe and effective in arthroplasty patients with severe comorbidities[J].Clin Orthop Relat Res,2014,472(1):66-72.
[11]Charoencholvanich K,Siriwattanasakul P.Tranexamic acid reduces blood loss and blood transfusion after TKA:a prospective randomized controlled trial[J].Clin Orthop Relat Res,2011,469(10):2874-2880.
[12]Yang ZG,Chen WP,Wu LD.Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis[J].J Bone Joint Surg(Am),2012,94(13):1153-1159.
[13]Maniar RN,Kumar G,Singhi T,et al.Most effective regimen of tranexamic acid in knee arthroplasty:a prospective randomized controlled study in 240 patients[J].Clin Orthop Relat Res,2012,470(9):2605-2612.
[14]Wong J,Abrishami A,El Beheiry H,et al.Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty:a randomized,controlled trial[J].J Bone Joint Surg(Am),2010,92(15):2503-2513.
[15]Mutsuzaki H,Ikeda K.Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty[J].J Orthop Surg Res,2012,7(1):32.