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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 6  |  Page : 638-642

Additional Dose of Intravenous Tranexamic Acid after Primary Total Knee Arthroplasty Further Reduces Hidden Blood Loss


1 Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
2 Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China

Correspondence Address:
Dr. Zi-Jian Li
Department of Orthopaedics, Peking University Third Hospital, Beijing 100191
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.226884

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Background: Total knee arthroplasty (TKA) is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid (TXA) is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss (TBL) came from hidden blood loss (HBL) on postoperative days 1 and 2. The role of reducing HBL with TXA administration in postoperative TKA patients is unknown. The current study was designed to evaluate the efficiency and safety of supplemental intravenous (IV) TXA in further reducing HBL after primary TKA. Methods: A prospective pilot study was conducted at a single institution on 43 consecutive patients who underwent unilateral TKA from September 2014 to February 2015. All patients were given 1 g of IV TXA 10–15 min before operation and another 1 g of IV TXA at the time of wound closure on the day of surgery. On postoperative days 1 and 2, the supplemental group (n = 21) was given additional 1 g of TXA intravenously twice a day, whereas the control group (n = 22) received an equal volume of saline. Drain output, hemoglobin (Hb), and hematocrit (HCT) were recorded preoperatively and 5 consecutive days postoperatively in both groups. HBL was calculated with the Gross formula. Pre- and post-operative lower extremity Doppler venous ultrasound was performed in all patients to detect deep vein thrombosis (DVT). The indexes were compared using the Mann-Whitney test, whereas the results of Hb and HCT were analyzed by repeated-measures analysis of variance. The difference was considered statistically significant if P < 0.05. Results: The demographics and surgical characteristics of the two groups were comparable. Supplemental group had higher Hb level on postoperative days 1–5 compared to the control; however, the difference was not significant (F = 2.732, P = 0.106). The HCT of the supplemental group was significantly higher than that of the control group on postoperative day 5 (F = 5.254, P = 0.027). No significant difference was found in drainage volume and TBL, but the HBL was reduced in the supplemental group (supplemental 133.1 [71.8, 287.3] ml and control 296.0 [185.3, 421.4] ml, Z = 2.478, P = 0.013, median [interquartile range]). There was one DVT in the control group and none in the supplemental group. All patients were followed at 1 year after surgery, and no further complications were reported. Conclusion: Based on the current study, additional doses of IV TXA could potentially further reduce HBL after primary TKA without increasing the risk of venous thromboembolism.

 

 Abstract in Chinese

初次膝关节置换术后额外静脉追加氨甲环酸可以进一步减少术后隐性失血量

摘要

背景:全膝关节置换术是治疗膝关节终末期骨性关节炎最常采用的手术方式。大量的围手术期失血经常会造成手术后贫血的发生。氨甲环酸作为纤溶抑制剂,常规是在手术开始前和伤口闭合时使用来减少手术的总体失血。我们既往的研究证实膝关节置换术后总失血量的三分之二是隐性失血,而在隐性失血阶段使用氨甲环酸的作用并不清楚。本研究旨在评价初次膝关节置换术后隐性失血阶段静脉追加使用氨甲环酸对于减少隐性失血的有效性和安全性。

方法:2014年9月至2015年2月期间,单一中心对43例单侧膝关节置换患者进行前瞻性序列研究。所有病人在手术开始前15分钟静脉给予氨甲环酸1g,在关闭伤口时静脉给予氨甲环酸1g。手术后第一天和第二天,额外追加组(n=21)静脉追加氨甲环酸每天两次,一次1g;对照组(n=22)接受等量的生理盐水。记录两组病人术后引流量以及术前和术后连续5天的血色素和红细胞压积。采用Gross方程计算隐性失血量。所有病人术前和术后接受多谱勒静脉超声检查明确有无下肢深静脉血栓形成。采用重复测量方差分析比较两组病人在血色素和红细胞压积变化趋势的差异,如果p<0.05,认为具有统计学上显著性差异。

结果:两组病人在一般资料和手术相关因素上具有可比性。额外追加组相比对照组在术后1-5天具有更高的血色素水平,尽管差异不具有统计学意义上的显著性 (F=2.732,p=0.106)。额外追加组的红细胞压积明显高于对照组(F=5.254,p=0.027)。两组间的引流量和总失血量未见显著差异,但额外追加组但隐性失血量更低[额外追加组133.1(71.8,287.3)ml,对照组296.0(185.3,421.4)ml,Z=2.478,p=0.013]。所有病人术后随访1年,未发现相关并发症。

结论:基于本研究,在初次膝关节置换术后额外静脉追加使用氨甲环酸具有进一步减少隐性失血的潜力,并不增加静脉血栓疾病的风险。



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