The efficacy and safety of multiple-dose intravenous tranexamic acid on blood loss following total knee arthroplasty: a randomized controlled trial

Abstract

Purpose: To assess the efficacy and safety of multiple-dose intravenous tranexamic acid (IV-TXA) on blood loss following total knee arthroplasty (TKA).

Methods: One hundred fifty nine patients received one bolus of IV-TXA before skin incision and two boluses three and six hours later (group A), or another bolus nine hours later (group B), or another two boluses nine and 12 hours later (group C). The primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum haemoglobin (Hb) drop. Other outcome measurements such as fibrinolysis parameters [fibrin(-ogen) degradation products (FDP), D-dimer], inflammatory factors [interleukin-6 (IL-6)], transfusion rate, range of motion (ROM), length of hospital stay (LOH), and complications were also recorded and compared.

Results: The mean TBL, HBL and maximum Hb drop in group C (p < 0.001, p < 0.001, p = 0.025) and group B (p = 0.025, p = 0.025, p = 0.044) were lower than those in group A. FDP and D-Dimer in group C was lower than in group A and B on post-operative day one. IL-6 in group A, B and C showed a downward tendency on post-operative days one and three (POD1 and POD3). Moreover, the ROM and LOH were better in group C. No episodes of transfusion or deep venous thrombosis (DVT) were detected in all groups.

Conclusions: The 5-dose TXA regimen can further reduce the blood loss, diminish the maximum Hb drop, minimize inflammation, enhance mobility, and shorten LOS following TKA, without increasing the risk of complications. An additional dose could be requisite when fibrinolysis maintains after 5-dose regimen has already been performed.

Level of evidence: I.

Keywords: Blood loss; Multiple-dose treatment; Randomized controlled trial; Total knee arthroplasty; Tranexamic acid.