Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty

Authors

  • Todd C. Kelley,

    1. Department of Orthopaedics, University of Cincinnati, Cincinnati, Ohio
    2. Oro Valley Hospital, Oro Valley, Arizona
    3. Towson Orthopaedic Associates, Towson, Maryland
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  • Kimberly K. Tucker,

    1. Department of Orthopaedics, University of Cincinnati, Cincinnati, Ohio
    2. Oro Valley Hospital, Oro Valley, Arizona
    3. Towson Orthopaedic Associates, Towson, Maryland
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  • Mary Jo Adams,

    1. Department of Orthopaedics, University of Cincinnati, Cincinnati, Ohio
    2. Oro Valley Hospital, Oro Valley, Arizona
    3. Towson Orthopaedic Associates, Towson, Maryland
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  • David F. Dalury

    Corresponding author
    1. Department of Orthopaedics, University of Cincinnati, Cincinnati, Ohio
    2. Oro Valley Hospital, Oro Valley, Arizona
    3. Towson Orthopaedic Associates, Towson, Maryland
    • Address reprint requests to: David F. Dalury, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780; e-mail: ehenze1@jhmi.edu.

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Abstract

Background

Tranexamic acid (TXA) is an antifibrinolytic that reduces blood loss and transfusion rates in total joint arthroplasty. Blood loss and allogenic transfusion rates have not been well studied in patients receiving TXA and undergoing bilateral staged total knee arthroplasty (TKA). The purpose was to evaluate the effect of TXA on blood loss, hemoglobin (Hb) changes, and transfusion in patients undergoing staged bilateral TKA.

Study Design and Methods

The authors compared 51 patients undergoing staged bilateral TKA who received TXA (2 g; subjects) with 70 who did not (controls). There were no significant differences between the groups in terms of demographics or preoperative Hb. For each TKA, 1 g of TXA was administered intravenously 15 minutes before incision and 1 g was administered intravenously at tourniquet release. Blood loss, Hb levels, and transfusions were recorded. Statistical analyses were performed using computer software. Significance was set at 0.05.

Results

Subjects had a significantly lower (p < 0.001) mean (±SD) blood loss (373.8 ± 264.6 mL vs. 871.6 ± 457.7 mL), significantly higher (p < 0.005) Hb levels on Postoperative Days 1 and 2, and a significantly lower (p < 0.001) mean (±SD) number of transfused allogenic blood units (0.60 ± 0.84 units vs. 1.53 ± 1.30 units).

Conclusions

TXA reduces blood loss, improves postoperative Hb, and decreases the allogenic blood transfusion requirements for patients undergoing bilateral staged TKA. TXA is an option for patients choosing bilateral staged TKA to decrease the risks associated with blood transfusion or when autologous blood is not available.

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