The Efficacy And Safety Of Tranexamic Acid On Reducing Blood Loss After Total Knee Arthroplasty

Objective:To evaluate the effect of intra-articular injection tranexamic acid on reducing blood loss in knee osteoarthritis patients in the primary total knee arthroplasty. Methods:Patients of knee osteoarthritis underwent primary total knee arthroplasty from 2014 January to 2015 March in the department of joint orthopaedics of the Second Affiliated Hospital of Shanxi Medical University were selected in this research. The exclusion were: severe knee joint varus deformity; using anticoagulant drugs currently, abnormal blood coagulation, blood diseases, anticoagulant drugs are not allergic to anticoagulant drug; hstory of thrombosis; atrial fibrillation,cardiac pacemaker or stent implantation in patients, and preoperative hemoglobin less than 90g/L. A total of Ninety-six patients were invovled in this study. They were divided into tranexamic acid group and control group randomly, 48 cases in each group. Indwelling drainage tube were used in both groups. In the tranexamic acid group, 50 ml tranexamic acid(100 ml containing 1g tranexamic acid and 0.7g sodium chloride) was injected intra-articular. In the control group, 50 ml saline solution was injected intra-articular. After clamping 3 h, the drainage was open. Hematocrit(HCT), Hemoglobin(HB), prothrombin time, and activated partial thromboplastin time were measured 12 hours and 72 hours postoperative. The loss of blood drainage was recorded 12 hours, 24 hours, and 48 hours postoperative. The dominant blood loss was calculated. Thrombosis were observed and examined. SPSS13.0 was used for statistic- al analysis the data. t-test was used to analysis the continuous variables, two independent groups of χ2 test was used to analysis the categorical variables, A statistically significant difference was defined as P < 0.05. Results:1, There were no statistically differences of the age, gender, height, body mass index, PT, APTT level, preoperative hemoglobin, preoperative HCT in the two groups(P > 0.05).2,Nineteen cases in the tranexamic acid group(39.5%) and 34 cases in the control group of(70.8%) received blood transfusion.3, There were statistically differences of the postoperative hemoglobin and hematocrit in the two groups(P < 0.05);4,The visible blood loss were 512 ml and 975 ml in the tranexamic acid group and in the control group respectively. The total blood loss were 354 ml and 805 ml in the tranexamic acid group and in the control group respectively. The blood loss after 12 hours were 284 ml and 565 ml in the tranexamic acid group and in the control group respectively.The blood loss after 24 hours were 60 ml and 161 ml in the tranexamic acid group and in the control group respectively. The blood loss after 48 hours were 9 ml and 75 ml in the tranexamic acid group and in the control group respectively. The blood loss were less in the tranexamic acid group than that in the control group(P < 0.05).5, All the incisions were primary healing. No serious complications and adverse reactions were observed. Conclusion:Intra-articular injection of tranexamic acid could reduce blood loss, decrease the rate of blood transfusion, without increasing the risk of thrombosis. It is a simple, safe and ef- fective way to reduce postoperative bleeding.