Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(03): 415-421
DOI: 10.1055/s-0041-1729933
Artigo Original

The Role of Tranexamic Acid in the Prevention and Management of Blood Loss in Total Joint Arthroplasty[*]

Article in several languages: português | English
Adarsh Thammaiah 
1   Departamento de Ortopedia, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, Índia
,
Siddalingamurthy Gajapurada 
1   Departamento de Ortopedia, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, Índia
,
Sanjana Nandakumar 
1   Departamento de Ortopedia, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, Índia
,
Purushotham Sastry 
1   Departamento de Ortopedia, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, Índia
,
Mruthyunjaya Mruthyunjaya 
1   Departamento de Ortopedia, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, Índia
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective To collect data on the role played by tranexamic acid in the prevention and management of blood loss in patients undergoing total hip arthroplasty and total knee arthroplasty.

Methods In the present prospective, comparative study, 30 patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomly allocated into 1 of 2 groups with 15 patients each. Tranexamic acid was administered by intravenous and topical routes in the study group, but it was not administered in the control group. Preoperative blood parameters, intraoperative and postoperative blood loss, and need for blood transfusion were noted. Statistical analysis was performed using the chi-squared test and the independent t-test.

Results The study group had statistically significant higher postoperative hemoglobin values (p = 0.03), less difference between pre and postoperative hemoglobin value (p = 0.046), less difference between pre and postoperative packed-cell volume (p = 0.06), less intraoperative measured blood loss (p = 0.015), and less volume of blood collected in the drain (p = 0.0291) compared with the control group. There was also reduced frequency of blood transfusions in the study group (p = 0.0008).

Conclusion Tranexamic acid is associated with reduced intra and postoperative blood loss and reduced frequency of blood transfusions in patients undergoing THA/TKA.

Keywords

blood loss, surgical - blood transfusion - arthroplasty, replacement, hip - knee - tranexamic acid

* Work developed at Department of Orthopaedics, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.




Publication History

Received: 13 June 2020

Accepted: 17 December 2020

Article published online:
25 October 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Fafalak M, Cushner F. Blood Loss in Orthopedic Surgery: A Historical Review. Tech Orthop 2017; 32 (01) 2-11
    CrossrefSearch in Google Scholar
  • 2 Guler N, Burleson A, Syed D. et al. Fibrinolytic Dysregulation in Total Joint Arthroplasty Patients: Potential Clinical Implications. Clin Appl Thromb Hemost 2016; 22 (04) 372-376
    CrossrefPubMedSearch in Google Scholar
  • 3 Huang Z, Huang C, Xie J. et al. Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty. Transfusion 2018; 58 (08) 1855-1862
    CrossrefPubMedSearch in Google Scholar
  • 4 Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion 2008; 48 (03) 519-525
    CrossrefPubMedSearch in Google Scholar
  • 5 Alshryda S, Mason J, Sarda P. et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H). J Bone Joint Surg Am 2013; 95 (21) 1969-1974
    CrossrefPubMedSearch in Google Scholar
  • 6 Chimento GF, Huff T, Ochsner Jr JL, Meyer M, Brandner L, Babin S. An evaluation of the use of topical tranexamic acid in total knee arthroplasty. J Arthroplasty 2013; 28 (8, Suppl): 74-77
    CrossrefPubMedSearch in Google Scholar
  • 7 Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 2013; 20 (05) 300-309
    CrossrefPubMedSearch in Google Scholar
  • 8 Zekcer A, Priori RD, Tieppo C, Silva RSD, Severino NR. Comparative study of topical vs. intravenous tranexamic acid regarding blood loss in total knee arthroplasty. Rev Bras Ortop 2017; 52 (05) 589-595
    Search in Google Scholar
  • 9 Wu YG, Zeng Y, Yang TM, Si HB, Cao F, Shen B. The Efficacy and Safety of Combination of Intravenous and Topical Tranexamic Acid in Revision Hip Arthroplasty: A Randomized, Controlled Trial. J Arthroplasty 2016; 31 (11) 2548-2553
    CrossrefPubMedSearch in Google Scholar
  • 10 Imai N, Dohmae Y, Suda K, Miyasaka D, Ito T, Endo N. Tranexamic acid for reduction of blood loss during total hip arthroplasty. J Arthroplasty 2012; 27 (10) 1838-1843
    CrossrefPubMedSearch in Google Scholar
  • 11 Gandhi R, Evans HM, Mahomed SR, Mahomed NN. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis. BMC Res Notes 2013; 6: 184
    CrossrefPubMedSearch in Google Scholar
  • 12 Liu X, Liu J, Sun G. A comparison of combined intravenous and topical administration of tranexamic acid with intravenous tranexamic acid alone for blood loss reduction after total hip arthroplasty: A meta-analysis. Int J Surg 2017; 41: 34-43
    CrossrefPubMedSearch in Google Scholar
  • 13 Poeran J, Rasul R, Suzuki S. et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ 2014; 349: g4829
    Search in Google Scholar
  • 14 Larson A, Hoitsma S, Metzger J, Oehlke K, Bebensee S. Impact of Tranexamic Acid on Blood Loss and Need for Blood Transfusions in Total Knee and Total Hip Arthroplasty. Fed Pract 2017; 34 (05) 14-19
    PubMedSearch in Google Scholar
  • 15 Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulisa L, De Santis E. Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am 2004; 86 (01) 57-61
    CrossrefPubMedSearch in Google Scholar
  • 16 Marchant Jr MH, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am 2009; 91 (07) 1621-1629
    CrossrefPubMedSearch in Google Scholar
  • 17 Aderinto J, Brenkel IJ. Pre-operative predictors of the requirement for blood transfusion following total hip replacement. J Bone Joint Surg Br 2004; 86 (07) 970-973
    CrossrefPubMedSearch in Google Scholar
  • 18 Carling MS, Jeppsson A, Eriksson BI, Brisby H. Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study. J Orthop Surg Res 2015; 10: 48
    CrossrefPubMedSearch in Google Scholar
  • 19 Singh AK, Narula GK, Nambiar BC, Bedi PS, Deeparani S, Rajkhowa M. Impact of tranexamic acid on coagulation parameters in patients undergoing total knee replacement surgeries under tourniquet: an observational study Int. J Res Med Sci 2018; 6 (04) 1144-1150
    Search in Google Scholar
  • 20 Zhang S, Huang Q, Xu B, Ma J, Cao G, Pei F. Effectiveness and safety of an optimized blood management program in total hip and knee arthroplasty: A large, single-center, retrospective study. Medicine (Baltimore) 2018; 97 (01) e9429
    CrossrefPubMedSearch in Google Scholar
  • 21 Grant AL, Letson HL, Morris JL. et al. Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study. J Orthop Surg Res 2018; 13 (01) 149
    CrossrefPubMedSearch in Google Scholar