The Effect of Intravenous Tranexamic Acid on Perioperative Blood Loss, Transfusion Requirements, Verticalization, and Ambulation in Total Knee Arthroplasty: A Randomized Double-Blind Study

Abstract

Background and Objectives: Total knee arthroplasty (TKA) is sometimes associated with significant perioperative bleeding. The aim of this study was to determine the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss in patients undergoing primary TKA. The secondary objectives were to assess the efficacy of TXA in reducing the need for blood transfusion in these patients and to determine its effect on verticalization and ambulation after TKA. Materials and Methods: This study included 96 patients who were randomly assigned to two groups, each containing 48 patients. The study group received intravenous TXA at two time points: immediately after the induction with doses of 15 mg/kg and 10 mg/kg 15 min before the release of the pneumatic tourniquet. The control group received an equivalent volume of 0.9% saline solution via the same route. Results: TXA markedly reduced (Z = -6.512, p < 0.001) the total perioperative blood loss from 892.56 ± 324.46 mL, median 800 mL, interquartile range (IQR) 530 mL in the control group, to 411.96 ± 172.74 mL, median 375 mL, IQR 200 mL, in the TXA group. In the TXA group, only 5 (10.4%) patients received a transfusion, while in the control group, 22 (45.83%) received it (χ2 = 15.536, p = 0.001). Patients in the study group stood (χ2 = 21.162, p < 0.001) and ambulated earlier postoperatively, compared to the control group (χ2 = 26.274, p < 0.001). Patients who received TXA had a better overall postoperative functional recovery. There was a statistically significant difference in all the above results. Conclusions: TXA is an effective drug for reducing the incidence of perioperative bleeding, decreasing transfusion rates, and indirectly improving postoperative functional recovery in patients undergoing primary TKA.

Keywords: ambulation; perioperative bleeding; total knee arthroplasty; tranexamic acid; transfusion; verticalization.

Figure 1

Graphic representation of the study design.

Figure 2

The box and whisker plot for intraoperative bleeding (mL). The box and whisker plot shows the median, minimum and maximum, interquartile range (IQR), and outliers (black circles), for intraoperative blood loss in both groups. There was a significantly higher intraoperative blood loss in the control group compared to the TXA group (Z = −6.931; p < 0.001).

Figure 3

The box and whisker plot showing postoperative blood loss after 6 h, 12 h, and 24 h and total postoperative blood loss. The box and whisker plot shows the median, IQR interquartile range, minimum and maximum, outliers (black circles), and extreme values (asterisk) of postoperative blood loss after 6 h, 12 h, and 24 h and total postoperative blood loss. There was a statistically significant difference between groups after 6 h (Z = −4.511, p < 0.001) and in total postoperative blood loss (Z = −4.319, p < 0.001).