Effectiveness and safety of tranexamic acid administration during total knee arthroplasty
Article first published online: 18 MAR 2008
© 2008 The Author(s). Journal compilation © 2008 Blackwell Publishing Ltd., Vox Sanguinis (2008)
Volume 95, Issue 1, pages 39–44, July 2008
How to Cite
Lozano, M., Basora, M., Peidro, L., Merino, I., Segur, J. M., Pereira, A., Salazar, F., Cid, J., Lozano, L., Mazzara, R. and Macule, F. (2008), Effectiveness and safety of tranexamic acid administration during total knee arthroplasty. Vox Sanguinis, 95: 39–44. doi: 10.1111/j.1423-0410.2008.01045.x
- Issue published online: 11 MAY 2008
- Article first published online: 18 MAR 2008
- Received: 11 February 2008, revised 11 February 2008, accepted 22 February 2008
- blood transfusion alternatives;
- total knee arthroplasty;
- tranexamic acid
Background The administration of tranexamic acid (TA) is associated with a decrease in the number of red blood cell (RBC) units transfused. However, concerns about its safety have hindered its broader use.
Study Design and Methods We evaluated the effect of TA on RBC transfusion and thromboembolic complications in total knee arthroplasty. We retrospectively studied 414 patients, 215 immediately before introducing TA treatment (control group) and after, in 199 patients without history of thromboembolic diseases (TA group). In a subgroup of patients, a lower extremities contrast venography was performed.
Results Fifty-four per cent of control group patients were transfused with RBC while only 17·6% of TA group patients received RBCs. In the TA that group, those transfused received less units (2·83 vs. 1·89), showed smaller mean calculated perioperative blood loss and haemoglobin values at discharge were higher compared to control group (10·1 vs. 9·3 g/dl). Thromboembolic complications were diagnosed in 2·8% of the patients in the control group and in 1·5% in the TA group. Asymptomatic distal deep venous thrombosis was found in 54 (14·8%) of TA group patients and 54 (30·1%) of control patients. TA administration reduced the expenditure for RBC transfusion plus the cost of TA from €148·94 to 33·87 per patient.
Conclusion Routine administration of TA during total knee arthroplasty to patients without history of thromboembolic disease is associated with a 67% reduction in RBC transfusions and, in those transfused, with a reduction in the number of units administered. TA treatment was not associated with an increase in thromboembolic complications. Transfusion costs are significantly reduced.