Efficacy And Safety Of Different Application Of TXA Combined With Drainage Tube Clamping In TKA

Background: Tranexamic acid(TXA)is an antifibrinolytic used in total knee arthroplasty(TKA)to reduce operative blood loss,hemoglobin loss,and the need for allogeneic transfusion in TKA patients.The administration of TXA can be administered locally through the knee joint,intravenously,or in combination.At present,whether the drainage tube should be clamped after the topical application of tranexamic acid is inconclusive,and the difference between the topical application and the combined application of tranexamic acid remains to be studied.In this study,we conducted a meta-analysis to investigate the effect of early drainage tube clamping and continuous drainage on drainage volume and blood loss after TKA,and further applied TXA in combination with different modalities to determine the optimal medication regimen of TXA in TKA surgery.Part ?: Meta-analysis of the effect of drainage tube clamping and continuous drainage on postoperative drainage volume and blood loss after TKA[Purpose] To systematically evaluate the effect of early clipping versus continuous drainage on postoperative drainage and blood loss after TKA.[Methods] CBM,CNKI,VIP,Wan Fang,PubMed,EMBASE,and the Cochrane Library were searched by the computer system.Two investigators independently completed literature screening,data extraction,and quality evaluation according to the inclusion criteria,and then used Review Manager 5.2 software to merge the data.[Results] A total of 18 randomized controlled trials were included,including 1233 patients.In the continuous open drainage tube group,the total drainage volume was reduced at 4h after drainage tube clamping(P < 0.00001),the drainage volume at 24 h after operation(P < 0.000 01),and the drainage volume at 48 h after operation(P < 0.000 01).The group with continuous opening of drainage tube for 4h after drainage tube clamping could reduce total blood loss(P < 0.0001),postoperative 24 h blood loss(P = 0.008)and postoperative 48 h blood loss(P < 0.000 01).Clamping the drainage tube for 4 hours reduced the amount of postoperative blood transfusion in the group with continuous opening of the drainage tube(P = 0.006).Clamping the drainage tube for 4 hours could reduce the Hb loss 24 hours after operation in the continuous opening group(P < 0.0000 1).[Conclusion] The available evidence shows that clamping the drainage tube for 4 hours can not only significantly reduce the drainage volume,blood loss,postoperative blood transfusion but also reduce the Hb loss 24 hours after TKA.Part ?: Efficacy and safety analysis of 4h drainage tube clamping combined with different modes of application of TXA in primary TKA[Purpose] To evaluate the efficacy and safety of different modalities of TXA application in TKA surgery under the condition of early drainage tube clamping for 4 hours.[Methods] A total of 84 patients who underwent TKA in our hospital from October 2017 to October 2019 and met the relevant inclusion and exclusion criteria were included and divided into two groups according to the method of TXA use: control group(combined administration regimen): intravenous drip of 1 g TXA 10 min after skin incision,and reverse injection of 2 g TXA into the drainage tube before incision closure(43 cases);experimental group(simple intra-articular TXA administration regimen): reverse injection of 3 g TXA into the drainage tube before incision closure(41 cases).The intraoperative blood loss,postoperative drainage volume,hemoglobin loss,continuous wound exudation and other complications were compared between the two groups.SPSS 25.0 software was applied to statistically analyze whether the differences between the groups were statistically significant.[Results] After analysis and comparison of the study,it was found that there was no significant statistical difference in hemoglobin loss,deep venous thrombosis,and postoperative drainage volume between the two groups under the condition of 4-hour drainage tube clamping(P > 0.05),and no major thrombotic events occurred in all study patients in the two groups.Although there was a statistically significant difference in the intraoperative blood loss and operation time between the two groups(P < 0.05),the combined regimen had less intraoperative bleeding and shorter operation time.However,there was no statistical significance in total blood loss and hospital stay between the two groups(P > 0.05).Both groups had different degrees of blood transfusion,but there was no statistical significance(P > 0.05).[Conclusion] The combined regimen differed from the intra-articular TXA regimen alone in terms of operation time and intraoperative blood loss,and preoperative intravenous TXA could reduce intraoperative bleeding,but did not affect total blood loss as well as drainage volume.In terms of postoperative complications,there were no differences between the two groups in terms of joint swelling,thrombosis,transfusion rate,persistent wound exudation,and deep infection related comparison.However,considering the potential complications associated with systemic administration,we do not recommend intravenous TXA during TKA and recommend intra-articular application of TXA alone.