Retrospective Comparative Analysis Of The Efficacy And Safety Of Intravenous Tranexamic Acid In The Bilateral Primary Total Knee Replacement

Objective:To investigate the influence of treating bilateral TKA patients with Tranexamic acid drips at different timing on peroperative hemorrhage and post operative venous thromboembolism. Methods:1、 Retrospective study 32 cases of primary bilateral TKA patients were selected from September 2012 to December 2014 and divided into 4 groups base on the drug programs.2、11 patients of group A received a dose of 15mg/kg Tranexamic acid(TA) intravenously 30 min before the operation and 30 min before closure the wound. 7 patients of group B received a dose of 15mg/kg TA intravenously 15 min before surgery. There were 8 patients of group C which received 15mg/kg TA intravenously 30 min before closure the wound and 6 patients of group D without using tranexamic acid.3、The following indexes were recorded : 24 h postoperative drainage volume,total drainage volume, times of blood transfusion, postoperative haemoglobin(Hb) level at 24 h,72h and 1w postoperative PT,APTT, FIB, 24 h D-dimer, VAS after surgery, level of bilateral knee joint passive movement 3d after surgery.4、Record the incidence rate of venous thromboembolism(VTE). Patients’ lower limbs were examined with doppler ultrasound 2 weeks postoperative. Results:1、The 24 h postoperative drainage volume,total drainage volume and blood transfusion rate in group ABC were significantly lower compare with group D(P<0.01,P<0.05,P<0.05) with group A being the least.2、The postoperative Hb level of group A was significantly higher than that in other groups(P < 0.05), this shows no significant difference within the four groups at 1 week after operation.3、2 cases(18%) of group A,3 cases(43%)of group B,3 cases(37%)of group C and 4 cases(50%) of group D were given blood transfusion, which were significantly lower than group D(P > 0.05). The postoperative level of D-dimer increased in all groups, from which group D were significantly higher than other groups(P < 0.05). There were no statistically significant differences in 24 hours postoperative PT, APTT, FIB and level of bilateral knee passive movement at day 3 after surgery.4、There were no VTE and DVT of lower limbs occurred in all groups that were studied. Conclusion:1、Tranexamic acid can reduce the perioperative blood loss of bilateral primary total knee replacement and can’t increase the rate of VTE. Tranexamic acid has no impact on rehabilitation postoperation.2、The intravenous infusion of 15 mg / kg of TXA 30 min before operation and 30 min before wound closure is both effective and safe in TKA and should be used widely.