Efficacy of 2 grammes of intravenous transexamic acid in the reduction of post-surgical bleeding after total hip and knee replacement

Abstract

Background: There is currently sufficient clinical evidence to recommend tranexamic acid (TXA) for reducing post-operative blood loss in total knee and hip arthroplasty, however, its optimal dose and administration regimes are unknown.

Objective: Analyse effectiveness and safety of TXA in total hip and knee arthroplasty using 2 grammes (g) intravenously in two different regimes.

Material and methods: A prospective randomised intervention study was conducted on a total of 240 patients. The patients were divided into 3 groups: 1) control; 2) 1g of TXA intraoperative, followed by another postoperative; and 3): 2g preoperative. Each group consisted of 40 patients undergoing total knee arthroplasty, and 40 total hip arthroplasty. Postoperative blood loss, transfusion rate, and thromboembolic complications were studied.

Results: There were significant differences (p<.005) when comparing mean total blood loss and transfusion between group 1 and 2, and between group 1 and 3, but not between the two TXA groups (2 and 3). The authors only recorded one complication in group 1 (deep vein thrombosis).

Discusion: This study was not performed to investigate the already well established effectiveness of TXA, but to confirm if 2 empirical intravenous g is safe, and what is most beneficial regimen. In conclusion, according to the literature, both proven patterns of 2g intravenous of TXA are effective in reducing blood loss and transfusion requirements, without increasing the complication rate.

Keywords: Blood loss; Complicaciones tromboembólicas; Sangrado; Thromboembolic complications; Tranexamic acid; Transfusion; Transfusión; Ácido tranexámico.