Knee surgery blood loss reduced with single tranexamic acid dose

By Lynda Williams

A single intraoperative dose of tranexamic acid is effective at reducing blood loss in patients undergoing minimally invasive total knee arthroplasty (TKA), research suggests.

Patients randomly assigned to receive tranexamic acid 10 mg/kg (n=52) 5 minutes before tourniquet deflation lost an average of 1035 mL. This did not significantly differ from the 986 mL lost by patients who were given tranexamic acid 10 mg/kg (n=49) 5 minutes before incision and again 5 minutes after tourniquet deflation.

Both losses were significantly lower than that of placebo-treated patients (n=50), report JW Wang and colleagues, from Kaohsiung Chang Gung Memorial Hospital in Taiwan.

The 15% and 19% reduction in blood loss with the one- and two-injection protocols, respectively, versus placebo was small compared with previously reported reductions of up to 52% for tranexamic acid use during routine TKA, notes the team, who say this may be due to the minimally invasive nature of the surgery.

The one- and two-injection protocols also offered a comparable and significant reduction in the need for transfusion compared with placebo (3.8 and 6.1 vs 22.0%).

Writing in the British edition of the Journal of Bone and Joint Surgery, the team reports that all patients were treated with postoperative low molecular weight heparin and there was just one deep vein thrombosis (DVT) episode reported. This occurred in a patient who received the two-injection protocol. No patients developed pulmonary embolism.

"Our results, as well as those of others, strongly suggest that use of [tranexamic acid] at a dose of 10 mg/kg does not increase the incidence of DVT following TKR," Wang et al conclude.

"However, only by screening for DVT by radioisotope venography could this finding be supported."

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