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. 2018 Sep 19;53(6):761-767.
doi: 10.1016/j.rboe.2018.09.008. eCollection 2018 Nov-Dec.

Evaluation of the use of tranexamic acid in total knee arthroplasty

Mariana Diana Chaves de Almeida  1 , Rodrigo Pires E Albuquerque  1 , Guilherme Mathias Palhares  1 , Juliana Patrícia Chaves de Almeida  2 , João Mauricio Barretto  1 , Naasson Cavanellas  1
Affiliations

Evaluation of the use of tranexamic acid in total knee arthroplasty

Mariana Diana Chaves de Almeida et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Objective: Evaluate the efficacy of tranexamic acid in reducing bleeding in patients undergoing total knee arthroplasty.

Methods: 101 patients were randomized into two groups: the tranexamic acid group (n = 51) and the placebo group (n = 50). Patients were compared regarding the following parameters: reduction of hemoglobin, total estimated blood loss, drain output, and postoperative blood transfusion rate.

Results: Comparing the groups, there were statistically significant differences (p < 0.05) in the following parameters: reduction of hemoglobin, decreased hematocrit, estimated blood loss, and drain output. All values were lower in the tranexamic acid group. Only placebo group patients required blood transfusion.

Conclusion: The use of intravenous tranexamic acid is effective to reduce bleeding in patients undergoing total knee arthroplasty.

Objetivo: Avaliar a eficácia do ácido tranexâmico na redução do sangramento em pacientes submetidos a artroplastia total de joelho.

Métodos: Foram randomizados 101 pacientes em dois grupos: grupo ácido tranexâmico (n = 51) e grupo placebo (n = 50). Os pacientes foram comparados nos quesitos redução da hemoglobina, perda sanguínea total estimada, débito do dreno e taxa de hemotransfusão pós-operatória.

Resultados: Na comparação entre os grupos, observou-se diferença estatística (p < 0,05) nos seguintes parâmetros: redução da hemoglobina, redução do hematócrito, perda sanguínea estimada e débito do dreno. Todos os valores foram menores no grupo do ácido tranexâmico. Somente pacientes do grupo placebo necessitaram de hemotransfusão.

Conclusão: O uso de ácido tranexâmico intravenoso é eficaz para reduzir o sangramento dos pacientes submetidos a artroplastia total de joelho.

Keywords: Bleeding; Blood transfusion; Blood volume; Orthopedic; Total knee arthroplasty; Tranexamic acid.

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Figures

Fig. 1
Fig. 1
Box plot of hemoglobin reduction results. The central line of each group represents its median and the rectangles (boxes) represent 50% of the patients in each group, comprised between the first and third quartiles. The lines that leave the boxes determine the upper and lower margins of the “typical” results found in each group. The point found in the control group is an outlier. Control group: minimum value = 0.1; maximum value = 7.7; first quartile = 2.0; third quartile = 4.2; median = 3.2. Tranexamic acid group: minimum value = −0.3; maximum value = 4.5; first quartile = 1.6; third quartile = 2.9; median = 2.3.
Fig. 2
Fig. 2
Box plot of hematocrit reduction results (%). Control group: minimum value = 0.4; maximum value = 22.9; first quartile = 6.1; third quartile = 13.9; median = 9.9. Tranexamic acid group: minimum value = 0.7; maximum value = 13.6; first quartile = 5.0; third quartile = 9.5; median = 7.3.
Fig. 3
Fig. 3
Box plot of estimated blood volume loss (L). Control group: minimum value = 0.1; maximum value = 4.0; first quartile = 0.7; third quartile = 1.6; median = 1.1. One outlier was observed in this group. Tranexamic acid group: minimum value = 0.1; maximum value = 1.6; first quartile = 0.5; third quartile = 1.1; median = 0.9.
Fig. 4
Fig. 4
Box plot of the drain output comparison (ml). Control group: minimum value = 0.0; maximum value = 900; first quartile = 150; third quartile = 550; median = 275. Tranexamic acid group: minimum value = 0.0; maximum value = 1200; first quartile = 40; third quartile = 250; median = 100. Three outliers were observed in this group.
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