The Effect Of Tranexamic Acid On Bleeding And Function After Unilateral Total Knee Arthroplasty

Objective:Making a comparative study on the effect of tranexamic acid received intravenously 30 min before deflation of the tourniquet on the bleeding and early recovery of joint function after unilateral total knee arthroplasty.Methods:From June 2014 to July 2015,72 patients who had undergone unilateral TKA were included in the study. The subjects were randomly divided into two groups by table of random number.The experimental group of 36 subjects received 15mg/kg TXA intravenously 30 min before deflation of the tourniquet. A control group of 36 subjects received an equal volume of normal saline intravenously 30 min before deflation of the tourniquet.1. By comparing dominant bleeding loss and hidden blood loss as well as proportion of patients with blood transfusion in two groups, to investigate the effect of tranexamic acid on bleeding after unilateral TKA.2. By comparing ROM of knees at operation and 3 d,7 d,2 weeks,1 month after operation as well as HSS and WOMAC score at 1 month and 3 months after operation in two groups, to investigate the effect of tranexamic acid on function after unilateral TKA.3. By comparing the incidence of deep venous thrombosis and pulmonary embolism in two groups, to investigate the safety of the use of tranexamic acid in TKA.Results:There was no significant difference between the general informtion of two groups before operation, the use of tourniquet during operation time. Dominant blood loss was significantly less in the experimental group(231.38±52.87)ml compare with the control group(301.11±97.04)ml. Hidden blood loss was significantly less in the experimental group (449.44±89.76)ml compare with the control group(651.67±139.48)ml. Blood transfusion rate was significantly less in the experimental group(11.1%) compare with the control group(33.3%). ROM of knees in the experimental group at 3 days,7 days,2 weeks and 1 month after operation were (56.39±5.02)°, (95.00±6.32)°, (110.42±8.48)°, (117.36±6.15)°, which were significantly higher than those of the same time point in control group(34.58±4.84)°, (86.67±8.86)°, (105.55±7.73)°, (114.17±5.41)°(P<0.05). The HSS score of the TXA group at 1 month and 3 months after operation was (78.72±2.47) and (87.47±3.38) was significantly higher than that in the control group (76.44±3.25) and (85.44±3.41) (P<0.05). In addition, the WOMAC score of the TXA group at 1 month and 3 months after operation was (33.22±5.17) and (29.61±4.67), which was smaller than that of the control group (36.28±5.21) and (32.17±4.71) (P<0.05). There were 4 cases of patients with muscular venous thrombosis in the TXA group, and 6 patients in the control group by color Doppler ultrasound, there is no significant difference between the two groups(P< 0.05). Besides there is no symptomatic DVT and PE in all of two groups within 3 months.Conclusion:1.15mg/kg of TXA intravenously 30 minutes before deflation of the tourniquet can reduce the bleeding and the proportion of blood transfusion after unilateral TKA.2.15mg/kg of TXA intravenously 30 minutes before deflation of the tourniquet is beneficial to the recovery of joint function after unilateral TKA.3.15mg/kg of TXA intravenously 30 minutes before deflation of the tourniquet in TKA will not increase the danger of DVT and PE.