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Optimal Dose and Safety of Topical Tranexamic Acid in Decreasing Blood Loss after Total Knee Arthroplasty
ESSKA Academy. Lee M. May 11, 2018; 218089; FP37-758
Myung Chul Lee
Myung Chul Lee
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Abstract
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Objectives: Total knee arthroplasty is a procedure that involves a significant amount of blood loss and often requires transfusion.Recently, tranexamic acid(TXA) has been known to be an effective method for reducing blood loss, and it is gradually becoming widely used in consideration of ease of use and efficacy.To reduce postoperative bleeding, topical injection doses ranging from 0.5 to 3 g have been reported, but the capacity to achieve maximum bleeding reduction with minimal side effects has not yet been fully studied.Therefore, this study aims to investigate the effective and efficacy and safety dose that can minimize the side effects and maximize the bleeding reduction effect.

Methods: From 2016 to 2017, 155 patients who will undergo total knee arthroplasty for osteoarthritis were randomly divided into five groups(control group(n=31), TXA 0.5g group(n=31), TXA 1.0g group(n=31), TXA 2.0g group(n=31), TXA 3.0g group(n=31)). During the operation, the joint capsule was closed and the drug was administered at the same concentration of 20 mg/ml through the H-vac line.The total blood loss was calculated using the Good's method using the difference between Preoperative hemogrobin and lowest postoperative hemogrobin and comprared each group.In addition, we observed differences in the drainage volume of hemo-vac, Hemogrobin reduction, transfusion rate, transfusion volume, and range of motion for each group.

Results: The mean total blood loss in each group was 1503ml in the control group, 1237.1ml in the 0.5 g group, 1090.1ml in the 1.0 g group,1097.1ml in the 2.0 g group and 905ml in the 3.0 g group. The degree of hemogrobin decreasing was 3.8 in the control group, 3.4 in the 0.5g group, 3.0 in the 1.0g group, 2.7 in 2.0g the group and 2.7 in 3g the group.There was a significant difference total blood loss and hemogrobin decreasing in the control group and the 1.0g group, control group and the 2.0g group, control group and the 3.0g group. And there was no statistically significant difference in the other groups including between the control group and the 0.5g group.The drainage volume of hemo-vac was 327.4 in the control group, 275.9ml in the 0.5 g group, 209 ml in the 1.0 g group, 241.8ml in the 2.0 g group and 156.0 ml in the 3.0 g group.There was a statistically significant difference in the frequency of transfusion among the other groups compared to the control group.

Conclusions: Comparing the groups according to the dose, the 0.5g group did not significantly decrease the total blood loss compared with the control group.On the other hand, total blood loss and transfusion rate were significantly decreased in all groups above TXA 1 g compared with the control group.Although the 1.0 g dose group did not significantly reduce the incidence of DVT compared with the group administered more than 1 g dose, To prevent meaningless drug abuse and to reduce potential thromboembolic risk that can not be explained by DVT alone, 1.0g topical injection of TXA is most effective and efficacy and safety dose.

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