Clinical Evaluation Of Pharmacokinetics,hemostatic Effect And Safety Of Different Administration Modes Of Tranexamic Acid In Total Knee Arthroplasty

Purpose:Total knee arthroplasty（TKA）is a major orthopaedic surgery with many postoperative complications.The amount of postoperative bleeding is related to the patient’s perioperative recovery.Therefore,how to reduce bleeding in the perioperative period to prevent the occurrence of bleeding-related complications and postoperative complications such as blood transfusion and infection is one of the important factors affecting the successful outcome of postoperative.Tranexamic acid has been widely used in surgical operations,including TKA hemostasis,and its hemostatic effect is relatively obvious.Currently,in the administration of tranexamic acid（TXA）,the commonly used intra-articular injection drugs,Intravenous infusion or combination of intravenous and articular cavity,but the specific mode of administration is not clear,This study investigated the effects of different administration routes on the pharmacokinetics,hemostatic effect and safety of TXA at the same dose.Methods:Sixty patients in the West Ward(7^thfloor)of the Joint Surgery Department of our hospital who were to undergo unilateral TKA were randomly divided into two groups.The experimental group was the same as the control group,with 30 patients in each group.The control group was given intravenous infusion of tranexamic acid 1g 30minutes before operation.The experimental group received local injection of tranexamic acid 0.5 g alone after the operation,and 0.5 g of tranexamic acid was intravenously infused 30 minutes before the operation during the operation.The total surgical blood loss,overt blood loss,hidden blood loss and postoperative drainage,preoperative and postoperative hemoglobin concentration（Hb）,hematocrit（Hct）,postoperative peripheral blood drug concentration,The incidence of lower extremity deep vein thrombosis（DVT）and incision healing were compared and analyzed.Results:Compared with the control group,there was no statistically significant difference in preoperative hemoglobin（Hb）and hematocrit（Hct）between the experimental group and the control group,respectively（P>0.05）.Hb and Hct between the two groups after operation were significantly difference（P<0.05）.The total blood loss,explicit and implicit blood loss of the two groups of patients undergoing surgical treatment were statistically different（P<0.05）.The postoperative drainage volume in the experimental group was 145.17±55.77ml,which was lower than that in the control group,which was 199.67±111.42ml,and the difference was statistically significant（P<0.05）.There was no significant difference in the incidence of lower extremity venous thrombosis（DVT）,postoperative redness and swelling of the surgical incision and recovery of the surgical incision between the two groups（P>0.05）.The drug concentrations were all within the effective concentration range at 2.5 and 4.5 hours postoperatively,The peripheral blood TXA plasma concentrations at 8.5 h after the operation in both groups were lower than the effective concentrations,and the drug concentrations at different time points between the two groups were compared,and there were significantly statistical differences（P<0.05）.Conclusions:Both intravenous administration and combined administration of TXA can significantly reduce postoperative bleeding after TKA within the effective concentration range.Compared with only intravenous infusion of TXA,intravenous infusion combined with local intra-articular injection of TXA can more effectively reduce perioperative blood loss and be safer with the lower concentration range.Significantly increased the occurrence of DVT,but also did not increase the risk of poor surgical incision healing,with certain safety.