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Comparison of Two Methods of Bolus and Infusion of Tranexamic Acid in Reduction of Blood Loss in Total Knee Arthroplasty

Mohammadreza Moshari, Bahman Malek, Mohammadreza Minator-Sajjadi, Maryam Vosoghian, Mastaneh Dahi, Mahshid Ghasemi, Razieh Shekari





BackgroundSo far, many studies have been performed to determine the optimal dose and regimen of tranexamic acid to reduce preoperative and postoperative blood loss in primary total knee arthroplasty. In the present study, two different methods of administration (bolus and infusion), were compared.

Materials and MethodsForty patients were randomized in the two groups (A and B) of 20 patients each. All patients received 500 mg tranexamic acid before inflation of tourniquet. Group A (mean age64± 6.1 years) received 500 mg tranexamic acid 10 minutes before loosening of tourniquet and group B (mean age, 63.5 ± 7.7 years) received 500 mg tranexamic acid through IV infusion during 6 hours from the time of tourniquet loosening (total dose of TA, 1 g in both groups). Intraoperative blood loss,postoperative drainage (in 6 and 12 hours), blood transfusion (in 48 hours), and decrease in hematocrit and hemoglobin (6 and 12 hours later), were compared between the two groups.

ResultsThe patients in group B had lower intra- and postoperative blood loss in 6 and 12 hours and also had lower decrease in hemoglobin, and their packed cell transfusion rate was significantly lower compared to the group A.

ConclusionThe findings of this study indicated that infusion administration of tranexamic acid in primary total knee arthroplasty, was more effective in the reduction of perioperative blood loss as well as need for blood transfusion in 48 hours.


Tranexamic Acid, Total Knee Arthroplasty,Postoperative Blood Loss


Wang G, Wang D, Wang B, Lin Y, Sun S. Efficacy and safety evaluation of intra-articular injection of tranexamic acid in total knee arthroplasty operation with temporarily drainage close. International Journal of Clinical and Experimental Medicine. 2015;8(8):14328-34.

Benoni G, Lethagen S, Fredin H. The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty. Thrombosis Research. 1997;85(3):195-206.

Tan J, Chen H, Liu Q, Chen C, Huang W. A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. The Journal of Surgical Research. 2013;184(2):880-7.

Georgiadis AG, Muh SJ, Silverton CD, et al. A prospective double-blind placebo controlled trial of topical tranexamic acid in total knee arthroplasty. The Journal of Arthroplasty. 2013;28(8 Suppl.):78-82.

Lee SH, Cho KY, Khurana S, Kim KI. Less blood loss under concomitant ad- ministration of tranexamic acid and indirect factor Xa inhibitor following total knee arthroplasty: a prospective randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(11):2611-7.

Zanasi S. Innovations in total knee replacement: new trends in operative treatment and changes in peri-operative management. European Orthopaedics and Traumatology. 2011;2(1-2):21–31. 7.Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. The Journal of Bone and Joint Surgery. 2009;91(6):776–83.

Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999;57(6):1005-32.

Lumsden MA, Wedisinghe L. Tranexamic acid therapy for heavy menstrual bleeding. Expert Opinion on Pharmacotherapy. 2011;12(13):2089–95.

Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. The Journal of Bone and Joint Surgery. 2008;90(9):1128-36.

Peng H, Weng X, Zhai J, et al. Use of intravenous tranexamic acid combined with temporary clamping of drain reduce postoperative blood loss in total knee arthroplasty. Chinese Journal of Orthopaedics. 2014;34(4):400-5.

Shemshaki H, Nourian SM, Nourian N, Dehghani M, Mokhtari M, Mazoochian F. One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Archives of Orthopaedic and Trauma Surgery. 2015;135(4):573-88.

Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clinical Orthopaedics and Related Research. 2012;470(9):2605-12.

MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. The Journal of Arthroplasty. 2011;26(1):24-8.

Mutsuzaki H, Ikeda K. Intra-articular injection of tranexamic acid via a drain plus drain- clamping to reduce blood loss in cementless total knee arthroplasty. Journal of Orthopaedic Surgery and Research. 2012;7:32.

Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. The Bone & Joint Journal. 2014;96-B(8):1005-15.

Yu X, Li W, Xu p, et al. Safety and efficacy of tranexamic acid in total knee arthroplasty. Medical Science Monitor. 2015;21:3095-103.

DOI: https://doi.org/10.22037/jcma.v3i1.18430


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