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The antifibrinolytic and anti-inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial

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Abstract

Purpose

The aim of this study was to evaluate the effects of a high initial-dose (60 mg/kg) intravenous tranexamic acid (IV-TXA) on fibrinolysis and inflammation after total knee arthroplasty (TKA).

Methods

A total of 132 patients were categorized into two groups based on different TXA regimens: 20 mg/kg before incision (A) or 60 mg/kg before incision (B). All patients received five doses of 1 g TXA at three, six, 12, 18, and 24 hours after the first dose. The primary outcomes were peri-operative blood loss and transfusion rate. Other outcome measurements such as, haemoglobin level, fibrinolysis parameters [fibrin(−ogen) degradation products (FDP), D-dimer], inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6)], visual analog scale (VAS) score, consumption of analgesic rescue, coagulation parameters [activated partial thromboplastin time (APTT), prothrombin time (PT), platelet count, thrombelastography (TEG), and anti-factor Xa activity (AFXa)] and complications, were also compared.

Results

There was a favourable effect in reducing peri-operative blood loss and transfusion rate for patients in Group B, compared with patients in Group A. In addition, the levels of FDP, D-dimer, CRP, IL-6, and dynamic pain in Group B were significantly lower than those in Group A on post-operative days one, two and three. There were no statistically significant differences in postoperative coagulation parameters and complications between the two groups.

Conclusion

A high initial-dose (60 mg/kg) IV-TXA before surgery followed by five doses can further reduce blood loss, provide additional fibrinolysis and inflammation control, and ameliorate post-operative pain following TKA, without increasing the risk of treatment-related complications.

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Acknowledgments

We acknowledge the nursing staffs from Department of Orthopedics Surgery, West China Hospital and the patients for their support during the study period. We thank Prof. Dan Deng (Department of Health Statistics and Information Management, College of Public Health and Management, Chongqing Medical University), for statistical counseling. Yi-Ting Lei wants to thank, in particular, the patience, care and support from Dan-Li Cui over the past few years.

Funding

This study was funded by the National Health and Family Planning Commission of the People’s Republic of China (CN) program (201302007).

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Author notes

  1. Fu-Xing Pei and Wei Huang contributed equally to this work and should be considered as equal

Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People’s Republic of China

    Yi-Ting Lei & Wei Huang

  2. Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People’s Republic of China

    Yi-Ting Lei, Jin-Wei Xie, Qiang Huang & Fu-Xing Pei

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  1. Yi-Ting Lei
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Correspondence to Wei Huang or Fu-Xing Pei.

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This trial was approved by the institutional review board (2017–128) and registered the International Clinical Trial Registry (ChiCTR1800016640).

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Informed consent was obtained from all individual participants included in the study.

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Lei, YT., Xie, JW., Huang, Q. et al. The antifibrinolytic and anti-inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial. International Orthopaedics (SICOT) 44, 477–486 (2020). https://doi.org/10.1007/s00264-019-04469-w

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