Effect Of Cocktail Therapy On Perioperative Blood Loss In Total Knee Arthroplasty

Objective: To evaluate the effect of tranexamic acid(TXA)plus epinephrine on reducing perioperative blood loss in unilateral total knee arthroplasty(TKA).Methods: Sixty-eight patients with primary severe osteoarthritis who underwent TKA in the Department of Orthopaedics,the Fourth Affiliated Hospital of China Medical University from November 2016 to September 2018 were randomly divided into two groups: cocktail group(n=36,tranexamic acid and epinephrine were injected into knee joint cavity)and the control group(n=32,only tranexamic acid was injected).Comparison was made between the two groups in total blood loss,hidden blood loss,allogeneic transfusion rate,the decrease of hemoglobin(Hb)and Hematocrit(Hct)at 3 days after operation,the change rates of thigh and calf girths,postoperative HSS score,postoperative knee mobility,and postoperative complications such as deep venous thrombosis of the lower extremities.Results: Compared with the control group,cocktail group significantly reduced total blood loss,hidden blood loss,the decrease of Hb and Hct at postoperative 3d,the change rates of thigh and calf girths,and the incidence of subcutaneous ecchymosis area > 1%,all P <0.05.Although there was no significant difference in the transfusion rate between the two groups(P= 0.203),the transfusion probability in the cocktail group was 2.8%,which was lower than the 15.6% in the tranexamic acid group.There was no significant difference in knee joint activity and HSS score at 3 months after suegery between the two groups(P=0.937,P=0.303).There were no significant differences in postoperative complications between the two groups(all P > 0.05).Conclusions: Tranexamic acid plus epinephrine is more effective in reducing perioperative blood loss during TKA than injection of tranexamic acid alone.