The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty
Abstract: Despite the advances
in the design and fixation of implants in total knee replacement (TKR). the
amount of postoperative bleeding is still an important issue that has not been
resolved. This study aimed to measure the effectiveness of various tranexamic
acid administration.
Methods: This was a randomized controlled trial study, held from August
2014 to February 2016 at Cipto Mangunkusumo Hospital, Jakarta. Twenty two
patients having TKR were divided into three groups: the control group, the
tranexamic acid intra-articular-intraoperative group, and the intravenous
preoperative group. Intraoperative bleeding, haemoglobin (Hb) level on preoperative
to five-day-post-surgery, total drain production, total blood tranfusion needed
and the drain removal timing were recorded and compared. Numerical data were
analyzed by using parametric and non-parametric test, depended on the normality
of the data.
Results: The amount of blood transfusion needed in both the
intra-articular group (200±SD 100 mL) and the intravenous group (238±SD 53 mL)
were significantly different compared to those in the control group (1,016±SD
308.2 mL) (p=0.001). Meanwhile, there was no significant difference between the
amount of blood transfusion needed in the intra-articular group and the
intravenous group. Total drain production in the intra-articular group (328±SD
193 mL) and intravenous group (391±SD 185 mL) was significantly different
compared to the control group (652±SD 150 mL) (p=0.003). No significant
difference between the levels of both preoperative and postoperative
haemoglobin, the amount of intraoperative bleeding, and the duration of drain
usage.
Conclusion: Intravenous and intra-articular tranexamic acid effectively
decreased transfusion volume and drain production in patients undergoing TKR.
Keywords: blood transfusion;
intravenous; intra-articular; postoperative bleeding; total drain; total knee
replacement; tranexamic acid
Author: Aryo N. Triyudanto,
Andri M.T. Lubis
Journal Code: jpkedokterangg160313
