Hemostatic effect and safety of intravenous drip of tranexamic acid combined with topical application of cocktail containing tranexamic acid in total knee arthroplasty / 中国组织工程研究

ABSTRACT

BACKGROUND: The perioperative blood loss of total knee arthroplasty is large. The “cocktail” containing tranexamic acid has the dual function of hemostasis and analgesia. However, how to further reduce blood loss with intravenous tranexamic acid is still worth exploring. OBJECTIVE: To compare the hemostatic effect and safety of tranexamic acid combined with different intravenous applications of tranexamic acid in total knee arthroplasty under the premise of using “cocktail” containing tranexamic acid. METHODS: Data of 62 patients with osteoarthritis, who underwent primary unilateral total knee arthroplasty in the First Department of Orthopedics of Zhongshan People’s Hospital from June 2017 to September 2019, were retrospectively analyzed and divided into three groups. In the Group A, 26 patients administrated “cocktail” containing tranexamic acid before closing the wound. In the Group B, 25 patients administrated intravenously 1.0 g tranexamic acid before cutting skin on the basis of group A. In the Group C, 11 patients administrated intravenously 1.0 g tranexamic acid on the basis of group B 3 hours postoperatively. Dominant, hidden, and total blood loss, postoperative hemoglobin biggest loss, blood transfusion rate, postoperative hospital stay and postoperative complications were compared and analyzed among three groups. RESULTS AND CONCLUSION: (1) In terms of blood loss (including total, hidden, intraoperative, postoperative and dominant) and the maximum loss of hemoglobin, both groups B and C were lower than group A, with statistically significant differences (P 0.05). (2) There were no statistically significant differences in blood transfusion rate and postoperative hospital stay among three groups (P > 0.05). (3) There were no statistically significant differences among the three groups in the incidence of wound complications, articular effusion, and complications of intermuscular vein thrombosis (P > 0.05). No lower limb deep vein thrombosis or pulmonary embolism was found in the three groups. (4) The results showed that intravenous administration of 1.0 g tranexamic acid before cutting skin and combination with “cocktail” containing 0.5 g tranexamic acid before closing the wound can have obvious hemostatic effect. However, intravenous administration of 1.0 g tranexamic acid 3 hours postoperatively failed to further reduce the bleeding; moreover, the first two administrations did not increase the postoperative complications, and had certain security.