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Does Tranexamic Acid Save Blood in Minimally Invasive Total Knee Arthroplasty?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Tranexamic acid (TEA) reportedly reduces perioperative blood loss in TKA. However, whether it does so in minimally invasive TKA is not clear.

Questions/purposes

We asked whether TEA would reduce blood loss and blood transfusion requirements after minimally invasive TKA.

Patients and Methods

We prospectively enrolled 100 patients who underwent minimally invasive TKAs: 50 received one intravenous injection of TEA before deflation of the tourniquet and a control group of 50 patients received an equivalent volume of placebo. We compared changes in hemoglobin, postoperative drainage, total blood loss, and transfusion rates between the two groups.

Results

The total blood loss was less for patients in the TEA group than for the control group: 833 mL (374–1014 mL) versus 1453 mL (733–2537 mL), respectively. The rate of blood transfusion also was less for patients in the TEA group than in the control group (4% versus 20%). The hemoglobin levels on the second and fourth postoperative days were greater for patients in the TEA group than in the control group.

Conclusions

Our data suggest one intraoperative injection of TEA decreased the total blood loss and need for transfusion after minimally invasive TKA.

Level of Evidence

Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Aderinto J, Brenkel IJ. Pre-operative predictors of the requirement for blood transfusion following total hip replacement. J Bone Joint Surg Br. 2004;86:970–973.

    Article  PubMed  CAS  Google Scholar 

  2. Arnljots B, Wieslander JB, Dougan P, Salemark L. Importance of fibrinolysis in limiting thrombus formation following severe microarterial trauma: an experimental study in the rabbit. Microsurgery. 1991;12:332–339.

    Article  PubMed  CAS  Google Scholar 

  3. Astedt B, Liedholm P, Wingerup L. The effect of tranexamic acid on the fibrinolytic activity of vein walls. Ann Chir Gynaecol. 1978;67;203–205.

    PubMed  CAS  Google Scholar 

  4. Benoni G, Carlsson A, Petersson C, Fredin H. Does tranexamic acid reduce blood loss in knee arthroplasty? Am J Knee Surg. 1995;8:88–92.

    PubMed  CAS  Google Scholar 

  5. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br. 1996;78:434–440.

    PubMed  CAS  Google Scholar 

  6. Bonutti PM, Mont MA, McMahon M, Ragland PS, Kester M. Minimally invasive total knee arthroplasty. J Bone Joint Surg Am. 2004;86(suppl 2):26–32.

    PubMed  Google Scholar 

  7. Brecher ME, Monk T, Goodnough LT. A standardized method for calculating blood loss. Transfusion. 1997;37:1070–1074.

    Article  PubMed  CAS  Google Scholar 

  8. Callaghan JJ, O’Rourke MR, Liu SS. Blood management: issues and options. J Arthroplasty. 2005;20:(4 suppl 2):51–54.

    Article  PubMed  Google Scholar 

  9. Camarasa MA, Ollé G, Serra-Prat M, Martin A, Sánchez M, Ricós P, Pérez A, Opisso L. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth. 2006;96:576–582.

    Article  PubMed  CAS  Google Scholar 

  10. Fahmy NR, Patel DG. Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet. J Bone Joint Surg Am. 1981;63:461–465.

    PubMed  CAS  Google Scholar 

  11. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90:596–599.

    Article  PubMed  CAS  Google Scholar 

  12. Haas SB, Cook S, Beksac B. Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop Relat Res. 2004;428:68–73.

    Article  PubMed  Google Scholar 

  13. Hiippala S, Strid L, Wennerstrand M, Arvela V, Mäntylä S, Ylinen J, Niemelä H. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth. 1995;74:534–537.

    Article  PubMed  CAS  Google Scholar 

  14. Husted H, Blønd L, Sonne-Holm S, Holm G, Jacobsen TW, Gebuhr P. Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty: a prospective randomized double-blind study in 40 patients. Acta Orthop Scand. 2003;74:665–669.

    Article  PubMed  Google Scholar 

  15. Ido K, Neo M, Asada Y, Kondo K, Morita T, Sakamoto T, Hayashi R, Kuriyama S. Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties. Arch Orthop Trauma Surg. 2000;120:518–520.

    Article  PubMed  CAS  Google Scholar 

  16. Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br. 2005;87:1480–1482.

    Article  PubMed  CAS  Google Scholar 

  17. Keating EM, Meding JB, Faris PM, Ritter MA. Predictors of transfusion risk in elective knee surgery. Clin Orthop Relat Res. 1998;357:50–59.

    Article  PubMed  Google Scholar 

  18. Kolisek FR, Bonutti PM, Hozack WJ, Purtill J, Sharkey PF, Zelicof SB, Ragland PS, Kester M, Mont MA, Rothman RH. Clinical experience using a minimally invasive surgical approach for total knee arthroplasty: early results of a prospective randomized study compared to a standard approach. J Arthroplasty. 2007;22:8–13.

    Article  PubMed  Google Scholar 

  19. Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC, Pavlov H, Petersen M. Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res. 2004;428:74–81.

    Article  PubMed  Google Scholar 

  20. Lotke PA, Faralli VJ, Orenstein EM, Ecker ML. Blood loss after total knee replacement: effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am. 1991;73:1037–1040.

    PubMed  CAS  Google Scholar 

  21. Mylod AG Jr, France MP, Muser DE, Parsons JR. Perioperative blood loss associated with total knee arthroplasty: a comparison of procedures performed with and without cementing. J Bone Joint Surg Am. 1990;72:1010–1012.

    PubMed  Google Scholar 

  22. Nadler SB, Hidalgo JU, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224–232.

    Google Scholar 

  23. Nakahara M, Sakahashi H. Effect of application of a tourniquet on bleeding factors in dogs. J Bone Joint Surg Am. 1967;49:1345–1351.

    PubMed  CAS  Google Scholar 

  24. National Institutes of Health Consensus Conference. Perioperative red blood cell transfusion. JAMA. 1988;260:2700–2703.

    Article  Google Scholar 

  25. Nilsson IM. Clinical pharmacology of aminocaproic and tranexamic acids. J Clin Pathol Suppl (R Coll Pathol). 1980;14:41–47.

    CAS  Google Scholar 

  26. Orpen NM, Little C, Walker G, Crawfurd EJ. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee. 2006;13:106–110.

    Article  PubMed  Google Scholar 

  27. Øvrum E, Am Holen E, Abdelnoor M, Oystese R, Ringdal ML. Tranexamic acid (Cyklokapron) is not necessary to reduce blood loss after coronary artery bypass operations. J Thorac Cardiovasc Surg. 1993;105:78–83.

    PubMed  Google Scholar 

  28. Pearse EO, Caldwell BF, Lockwood RJ, Hollard J. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br. 2007;89:316–322.

    Article  PubMed  CAS  Google Scholar 

  29. Petäjä J, Myllynen P, Myllylä G, Vahtera E. Fibrinolysis after application of a pneumatic tourniquet. Acta Chir Scand. 1987;153:647–651.

    PubMed  Google Scholar 

  30. Risberg B. The response of the fibrinolytic system in trauma. Acta Chir Scand Suppl. 1985;522:245–271.

    PubMed  CAS  Google Scholar 

  31. Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty: correct management of blood loss should take hidden blood loss into account. J Bone Joint Surg Br. 2004;86:561–565.

    PubMed  CAS  Google Scholar 

  32. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br. 2001;83:702–705.

    Article  PubMed  CAS  Google Scholar 

  33. Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamoto Y. Minimally invasive versus standard approach in total knee arthroplasty. Clin Orthop Relat Res. 2007;463:144–150.

    PubMed  Google Scholar 

  34. Tenholder M, Clarke HD, Scuderi GR. Minimal-incision total knee arthroplasty: the early clinical experience. Clin Orthop Relat Res. 2005;440:67–76.

    Article  PubMed  Google Scholar 

  35. Tria AJ Jr, Coon TM. Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res. 2003;416:185–190.

    Article  PubMed  Google Scholar 

  36. Wang CJ, Wang JW, Weng LH, Hsu CC, Huang CC, Yu PC. Prevention of deep-vein thrombosis after total knee arthroplasty in Asian patients: comparison of low-molecular-weight heparin and indomethacin. J Bone Joint Surg Am. 2004;86:136–140.

    PubMed  Google Scholar 

  37. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, Clement C, Robinson KS, Lewandowski B. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350:1795–1798.

    Article  PubMed  CAS  Google Scholar 

  38. Yamasaki S, Masuhara K, Fuji T. tranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty. J Bone Joint Surg Am. 2005;87:766–770.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan, ROC 

    Po-Chun Lin MD, Chi-Hsiang Hsu MD, Wun-Schen Chen MD & Jun-Wen Wang MD

Authors
  1. Po-Chun Lin MD
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  2. Chi-Hsiang Hsu MD
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  3. Wun-Schen Chen MD
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  4. Jun-Wen Wang MD
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Correspondence to Jun-Wen Wang MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity of interest, patient/licensing arrangement, etc) that might pose a conflict of interest in connection with submitted article.

One or more of the authors (PCL, CHH, WSC, JWW) has received funding from research grant from Chang Gung Memorial Hospital (CMRPG870741).

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in research was obtained.

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Lin, PC., Hsu, CH., Chen, WS. et al. Does Tranexamic Acid Save Blood in Minimally Invasive Total Knee Arthroplasty?. Clin Orthop Relat Res 469, 1995–2002 (2011). https://doi.org/10.1007/s11999-011-1789-y

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  • DOI: https://doi.org/10.1007/s11999-011-1789-y

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