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Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Tranexamic acid (TXA) is widely used in the orthopedic field and particularly in total knee arthroplasty (TKA). Its efficacy and safety in reducing the blood loss in TKA have been well-documented in the current literature. Little data regarding TKA without tourniquet and TXA exist. Our aim is to compare three different dosages of intravenous (IV) TXA in TKA without tourniquet.

Materials and methods

A total of 180 patients undergoing TKA for knee osteoarthritis were stratified in three equal groups. All surgeries were performed under spinal anesthesia, without tourniquet. Group A (60 patients) received 15 mg/kg of IV TXA given on induction, Group B (60 patients) received an additional dose of IV TXA (15 mg/kg) 3 h after incision and Group C (60 patients) received an additional (third) dose 3 h later (15 mg/kg). The measured outcomes were the change in hemoglobin (Hb) from pre-operatively to post-operatively, the amount of blood transfusion given (units), the functional and quality of life (QoL) and pain assessment based on their corresponding scoring system.

Results

Calculated blood loss, Hb decrease and transfusion rate were significantly lower in Group C (p value < 0.05). Additionally, patients that had been included in the three-dosage group benefited much more in terms of faster rehabilitation, better QoL, decreased post-operative pain, with no increase in complications.

Conclusion

According to our results, three doses of IV TXA have effectively and safely reduced blood loss and the need of allogeneic blood transfusion in patients undergoing TKA without tourniquet, with additional patients-related benefits.

Level of evidence

II.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece

    Themistoklis Tzatzairis, Georgios I. Drosos, Konstantinos Tilkeridis, Athanasios Ververidis & Konstantinos Kazakos

  2. Department of Anesthesia, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece

    Theodosia Vogiatzaki

Authors
  1. Themistoklis Tzatzairis
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  2. Georgios I. Drosos
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  3. Theodosia Vogiatzaki
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  4. Konstantinos Tilkeridis
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  5. Athanasios Ververidis
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  6. Konstantinos Kazakos
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Correspondence to Themistoklis Tzatzairis.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Tzatzairis, T., Drosos, G.I., Vogiatzaki, T. et al. Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study. Arch Orthop Trauma Surg 139, 859–868 (2019). https://doi.org/10.1007/s00402-019-03173-z

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  • DOI: https://doi.org/10.1007/s00402-019-03173-z

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