2015 ISAKOS Biennial Congress ePoster #1437

Effect of a Single Injection of Tranexamic Acid on Blood Loss After Primary Hybrid TKA

Yoshinori Ishii, MD, Gyoda, Saitama JAPAN
Hideo Noguchi, Gyoda, Saitama JAPAN
Junko Sato, MD, PhD, Gyoda, Saitama JAPAN
Ishii Orthopaedic & Rehabilitataion Clinic, Gyoda, Saitama, JAPAN

FDA Status Cleared

Summary: The administration of one 1000 mg dose of intravenous tranexamic acid just before deflation of the tourniquet during hybrid TKA might be a good means of controlling postoperative blood loss.

Abstract:

Background

Control of perioperative blood loss is important in total knee arthroplasty (TKA), especially cementless or hybrid TKA. There is increasing interest in the use of tranexamic acid (TXA) for this purpose; however, studies to date have mainly evaluated the effects of various TXA administration regimens on patients who underwent cemented TKA. We sought to determine (1) whether administration of TXA reduces blood loss after hybrid TKA, and (2) whether an autologous blood reinfusion system is necessary in TKA patients who are treated with TXA.

Methods

Ninety-five patients (100 knees) who underwent hybrid primary TKA (cemented tibia, uncemented femur) were included in this study. The initial 50 knees were treated without TXA and the following 50 were treated with TXA. Intravenous TXA (1000mg) was administered shortly before deflation of the tourniquet. All continuous variables are expressed as median [25th percentile, 75th percentile].

Results

Total volumes of blood lost at postoperative 1 day were 590 ml [403, 950] and 150 ml [100, 250] and autotransfusion of collected blood was performed in 88 % and 16% of patients in the without and with TXA groups, respectively. The without TXA group lost a median of 450 ml [275,658] of blood within 3 h after surgery and 150 ml [60,293] of blood from 3 h to the first postoperative day and the with TXA group lost a median of 70 ml [50, 100] and 95 ml [41,150] of blood, respectively. A median volume of 400 ml [203, 608] of collected blood was returned to the patients in the without TXA group, and 0 ml [0, 0] to the patients in the with TXA group. The calculated volumes of blood lost were 761 ml [565,924] and 683 ml [549, 823] (p=0.2250), respectively.

Discussion

Our results indicate that the use of TXA and a postoperative autotransfusion system have comparable effects on postoperative blood loss in hybrid TKA surgery. In the non-TXA group, the most bleeding occurred during the initial 3 hours after surgery (approximately 3 times more blood was lost during this time than during the 3 hours – 1 day postoperative period). The blood collected during the initial 3 hours after surgery (median volume approximately 400 ml) was returned to the patients within 6 hours postoperatively. In contrast, based on the pharmacokinetics and bioavailability of TXA the apparent elimination half-life of TXA is approximately two hours, with most elimination occurring through renal excretion. Thus, the greatest pharmacological effect of TXA in the TXA group might have coincided with the time of maximum bleeding (the first 3 postoperative hours) in the non-TXA group.

Conclusions

One intravenous injection of 1000 mg TXA may help to control postoperative blood loss and reduce the need for postoperative autologous blood reinfusion after hybrid TKA.