J Knee Surg 2021; 34(02): 224-232
DOI: 10.1055/s-0039-1694768
Original Article

Six-Dose Intravenous Tranexamic Acid Regimen Further Inhibits Postoperative Fibrinolysis and Reduces Hidden Blood Loss following Total Knee Arthroplasty

Shaoyun Zhang
1   Department of Orthopedics, The Third Hospital of Mianyang Sichuan Mental Health Center, Mianyang, People's Republic of China
2   Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
,
Jinwei Xie
2   Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
,
Guorui Cao
2   Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
,
Yiting Lei
2   Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
,
Qiang Huang
2   Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
,
Fuxing Pei
2   Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
› Author Affiliations
Funding This study was funded by the National Health and Family Planning Commission of the People's Republic of China (CN) program (201302007).

Abstract

There is no consensus regarding the ideal dosages and times of multiple-dose intravenous tranexamic acid (IV-TXA) administration in total knee arthroplasty (TKA). This study aimed to assess the effect of six-dose IV-TXA with the total dosage more than 6 g on postoperative fibrinolysis and hidden blood loss (HBL) after primary TKA. A total of 175 patients were randomized into three groups to receive placebo (group A), or a single preoperative dose of 20 mg/kg IV-TXA (group B), or six-dose IV-TXA from the beginning of the procedure to subsequent 24 hours with the total dosage more than 6 g (group C). The calculated HBL, maximum hemoglobin (Hb) drop, transfusion rate, and the incidence of thromboembolic events were compared among groups. The levels of fibrinolysis parameters in plasma including fibrin(-ogen) degradation products (FDP) and D-dimer were measured at six time points from preoperatively to 3-month postoperative period. The mean HBL and maximum Hb drop in group C (515.51 ± 245.79 mL, and 2.06 ± 0.73 g/dL, respectively) were significantly lower than those in groups B (756.06 ± 226.79 mL, p < 0.001; and 2.77 ± 0.78 g/dL, p < 0.001, respectively) and A (987.65 ± 275.38 mL, p < 0.001; and 3.49 ± 0.86 g/dL, p < 0.001, respectively). Such differences were also detected between groups A and B (p < 0.001 and p < 0.001, respectively). The levels of FDP and D-dimer in plasma were lower in group C than those in groups B and A on postoperative 24, 48, 72 hours (p < 0.001 for all). No episode of transfusion occurred, and the incidence of thromboembolic events were similar among groups (p > 0.05). The administration of six-dose IV-TXA during the first 24 hours resulted in reduced HBL following TKA without a measured increase in thromboembolic events.

Shaoyun Zhang and Jinwei Xie contributed equally to this work and should be considered as equal first authors.




Publication History

Received: 11 November 2018

Accepted: 03 July 2019

Article published online:
21 August 2019

© 2019. Thieme. All rights reserved.

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