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Randomized Controlled Trial
. 2021 May 7;22(1):425.
doi: 10.1186/s12891-021-04307-4.

Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

Bing-Xin Kang  1 , Hui Xu  1 , Chen-Xin Gao  1 , Sheng Zhong  1 , Jing Zhang  1 , Jun Xie  1 , Song-Tao Sun  1 , Ying-Hui Ma  1 , Xi-Rui Xu  1 , Chi Zhao  1 , Wei-Tao Zhai  1 , Lian-Bo Xiao  2   3 , Xiao-Jun Gao  4
Affiliations
Randomized Controlled Trial

Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

Bing-Xin Kang et al. BMC Musculoskelet Disord. .

Abstract

Background: We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA).

Methods: For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50-75 years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1 g IV-TXA 10 min before skin incision, followed by articular injection of 1.5 g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay.

Results: The mean TBL, HBL, and maximum Hb level decrease in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in group A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 (P < 0.001), and the incidence of thromboembolic events was similar between the groups (P > 0.05).

Conclusion: In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA.

Trial registration: The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR1900025013 ).

Keywords: Blood loss; Rheumatoid arthritis; Total knee arthroplasty; Tranexamic acid.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting (CONSORT) flow diagram. Name of the registry: Clinical observation of multiple dose administration of tranexamic acid in patients with rheumatoid arthritis after total knee arthroplasty. Prospective registration, ChiCTR1900025013. Registered 7 August 2019,
See this image and copyright information in PMC

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