St. Hiippala et al., TRANEXAMIC ACID RADICALLY DECREASES BLOOD-LOSS AND TRANSFUSIONS ASSOCIATED WITH TOTAL KNEE ARTHROPLASTY, Anesthesia and analgesia, 84(4), 1997, pp. 839-844
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.