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Is Combined Administration of Tranexamic Acid Better than Both Intravenous and Topical Regimes for Total Loss, Hidden Loss and Post-operative Swelling? A Randomized Control Trial

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Bleeding is one of the unavoidable complications of total knee arthroplasty (TKA). Tranexamic acid (TXA) in last decade has emerged as an effective and safe way to decrease postoperative bleeding and transfusion rates. Although there is little doubt on the efficacy of the drug, the debate on ideal mode is more recent. We undertook this study to find out the most effective and yet safest way of TXA administration.

Materials and Methods

A single institution - two hospital-based, double-blinded, prospective, randomized control trial was conducted from January 2015 to December 2015. One hundred and fifty patients were randomly divided in one of the three groups using computer-generated tables - intravenous (IV), intraarticular and combined. Evident loss through drain, total loss based on gross method and hemoglobin balance method, hidden blood losses, hemoglobin, and hematocrit drop, all possible complications related to TXA were evaluated and compared among groups. The analysis of variance and Tukey’s post hoc were used for continuous outcome variables and Chi-square test for binary outcome variables.

Results

Evident loss in combined group was 574.25 ± 209.8 ml, significantly less than IV (685.4 ± 289.9 ml) and intraarticular group (724.3 ± 246.8 ml). Total loss was similarly least for combined group (930.1 ± 262.2 ml) compared to IV (1208.3 ± 368.8 ml) and intraarticular group (1198.1 ± 356.8 ml). There were no transfusions in combined group compared to five in IV and four in intraarticular group. Combined group also had least hidden losses after surgery. No patients in any group developed symptomatic deep venous thrombosis.

Conclusion

Combined administration of drug is most effective way to decrease postoperative bleeding and requirement of transfusion in unilateral TKA without increasing any risk of complications.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, 80, Deongnam-gil, Nam-gu, Gwangju, 503-340, Korea

    Jatin Prakash, Jong-Keun Seon, Eun-Kyoo Song, Dong-Hyun Lee, Hong-Yeol Yang & Cheng Jin

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  1. Jatin Prakash
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  2. Jong-Keun Seon
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  3. Eun-Kyoo Song
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Correspondence to Eun-Kyoo Song.

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Prakash, J., Seon, JK., Song, EK. et al. Is Combined Administration of Tranexamic Acid Better than Both Intravenous and Topical Regimes for Total Loss, Hidden Loss and Post-operative Swelling? A Randomized Control Trial. IJOO 52, 117–123 (2018). https://doi.org/10.4103/ortho.IJOrtho_179_16

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