Effects & Safety Of Tranexamic Acid In Primary Total Knee Arthroplasty

ObjectiveTo investigate the effect of the intra-operative use of tranexamic acid on blood loss, postoperative knee function, the impact of postoperative pain in primary total knee arthroplasty surgery, and the safety of the tranexamic acid.MethodsWe retrospectively reviewed 104 patients from August 2013 to April 2015 underwent total knee arthroplasty in Zhongda Hospital. Patients were divided into three groups: Group A (the control group, patients without use of tranexamic acid, n=31), Group B (local groups, patients using 0.5 g tranexamic acid in the local, n=35), Group C (combination group, patients using 0.5g tranexamic acid in the local and 0.5g tranexamic acid intravenously infused, n=38). Analysis of the general situation, preoperative Hct, HSS score, VAS of three groups of patients. Comparison of perioperative blood lose, blood transfusion rate, per capita amount of blood transfusion, PT, APTT, postoperative HSS score, VAS of three groups of patients. All patients were observed for whether they had deep vein thrombosis at one week after TKA and cerebral infarction, myocardial infarction at one year after TKA.ResultsThree groups of patients in the general situation, preoperative Hct, preoperative HSS, preoperative VAS had no significant difference (P>0.05), there are comparable. In the local group, the postoperative drainage volume was (376.14+73.22) ml, the hidden blood loss was (381.87+78.58) ml, the rate of blood transfusion was 1/35, the per capita amount of blood transfusion was 1 u red blood cells, the postoperative HSS score was (83.54±3.86), the VAS at 24h after TKA was (4.71±1.073).In the combination group, the postoperative drainage volume was (366.18±85.80)ml, the hidden blood loss was (357.02±80.53) ml, the rate of blood transfusion was 1/38, the per capita amount of blood transfusion was 1u red blood cells, the postoperative HSS score was (84.58±4.20), the VAS at 24h after TKA was (4.71±1.494). In the control group, the postoperative drainage volume was (540.00±99.16) ml, the hidden blood loss was (599.55±120.26) ml, the rate of blood transfusion was 5/31, the per capita amount of blood transfusion was 2.1u red blood cells, the postoperative HSS score was (78.39±4.01), the VAS at 24h after TKA was (7.19±0.792). There was statistically significant difference in the obvious blood loss, the hidden blood loss, the rate of blood transfusion, the per capita amount of blood transfusion, the postoperative HSS score and the VAS at 24h after TKA between the three groups (P<0.05), but no significant difference between the local group and the combination group(P>0.05). There was no significant difference in the VAS at 48h after TKA, the postoperative PT and APTT between the three groups (P>0.05). No patients were found to have lower extremity deep vein thrombosis at one week after TKA and cerebral infarction, myocardial infarction at one year after TKA.ConclusionIn the unilateral primary TKA, tranexamic acid significantly reduce the obvious blood loss, the hidden blood loss, transfusion rate and per capita amount of blood transfusion, but no significant difference in reducing blood loss, transfusion rate and the per capita amount of blood transfusion with different ways. Tranexamic acid was significantly beneficial to patients with early postoperative knee function recovery, but no significant difference in the early days on recovery of knee joint function with different way. Tranexamic acid is helpful to ease the pain of 24 h after TKA. Tranexamic acid did not affect the blood coagulation function and did not increase the risk of patients with DVT at one week after TKA and cerebral infarction, myocardial infarction at one year after TKA.