TRANEXAMIC ACID RADICALLY DECREASES BLOOD-LOSS AND TRANSFUSIONS ASSOCIATED WITH TOTAL KNEE ARTHROPLASTY

The application of a pneumatic tourniquet in orthopedic procedures enh ances local fibrinolysis. Consequently, a short-term antifibrinolytic therapy may be indicated in this clinical situation to reduce postoper ative blood loss. The purpose of this prospective double-blind study w as to investigate the effect of tranexamic acid (TA) on blood loss ass ociated with total knee arthroplasty (TKA). Seventy-five patients sche duled for 77 TKAs were randomized to receive either TA (n = 39) or equ al volume of normal saline (NS, n = 38). Before deflation of the tourn iquet, 15 mg/kg of TA was given intravenously followed by two 10-mg/kg additional doses. Perioperative blood loss gathered in surgical gauze s, suction reservoirs, and postoperative drainage system was measured. The number of transfusions given during hospitalization was registere d. Total blood loss (mean +/- SD) was 689 +/- 289 mt in the TA group a nd 1509 +/- 643 mt in the NS group (P < 0.0001). The mean number of tr ansfused red cell units in the TA group was 1.0 +/- 1.2 compared to 3. 1 +/- 1.6 in the NS group (P < 0.0001). Twenty-two patients in the TA group and four patients in the NS group were treated without transfusi on (P < 0.00003). Two patients in the TA group and three in the NS gro up had a deep venous thrombosis, including a fatal case of pulmonary e mbolism in the NS group. We conclude that short-term TA therapy signif icantly reduces TKA-associated blood loss and transfusion requirements without increasing thromboembolic complications.