Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty

Abstract

Fibrin sealant (FS) and tranexamic acid (TXA) have been used in total knee arthroplasty (TKA) to minimize perioperative blood loss. The efficacy of FS has been debated, and few studies have looked into the effects of FS and TXA on perioperative coagulability. The current study retrospectively reviewed 100 cases of unilateral primary TKA. Twenty-five cases served as blank controls, FS was used without TXA in 23, TXA was used without FS in 20, and both FS and TXA (FS + TXA) were used in 32. FS was sprayed before wound closure whereas 1 g of TXA was intravenously administered before incision and 1 g was administered 15 min before tourniquet release. Hematocrit and hemoglobin levels and thromboelastography (TEG) parameters were assessed pre-operatively and on day 1, 4, and 9 post-operatively. Blood transfusions were noted and the incidence of symptomatic DVT/PE was determined. Hematocrit and hemoglobin levels were significantly higher in the TXA and FS + TXA groups compared to the control and FS groups on day 1, 4, and 9 post-operatively. Hematocrit and hemoglobin levels in the control group were similar to those in the FS group and hematocrit and hemoglobin levels in the TXA group were similar to those in the FS + TXA group. TEG parameters (R, K, α, MA, and CI) remained within normal ranges. Mean CI was less than +3 in all four groups, suggesting that hypercoagulation was not promoted. One patient in the FS group received an allogeneic transfusion. Incidence of symptomatic DVT/PE was not noted. Intravenous TXA significantly reduced perioperative blood loss in patients undergoing a TKA but FS did not. Administration of FS in addition to TXA was not superior to TXA alone. FS and/or TXA did not increase the risk of hypercoagulation according to TEG parameters. Intravenous administration of 1 g of TXA pre-operatively and administration of 1 g before tourniquet release is an effective and safe method of reducing blood loss in TKA.