Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty

• Published in: Transfusion (Philadelphia, Pa.) Vol. 54; no. 1; pp. 26 - 30
• Main Authors: Kelley, Todd C., Tucker, Kimberly K., Adams, Mary Jo, Dalury, David F.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Blackwell Publishing Ltd 01.01.2014; Wiley; Wiley Subscription Services, Inc
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antifibrinolytic Agents - therapeutic use; Arthroplasty, Replacement, Knee - adverse effects; Biological and medical sciences; Blood Transfusion - statistics & numerical data; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Female; Humans; Knee - physiology; Male; Medical sciences; Middle Aged; Postoperative Hemorrhage - prevention & control; Range of Motion, Articular - physiology; Retrospective Studies; Tranexamic Acid - therapeutic use; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Knee; Human; Transfusion; Hemostatic; Prosthesis; Use; Blood loss; Tranexamic acid; Bilateral; Patient; Antifibrinolytic; Result
• ISSN: 0041-1132; 1537-2995; 1537-2995
• DOI: 10.1111/trf.12167

Background Tranexamic acid (TXA) is an antifibrinolytic that reduces blood loss and transfusion rates in total joint arthroplasty. Blood loss and allogenic transfusion rates have not been well studied in patients receiving TXA and undergoing bilateral staged total knee arthroplasty (TKA). The purpose was to evaluate the effect of TXA on blood loss, hemoglobin (Hb) changes, and transfusion in patients undergoing staged bilateral TKA. Study Design and Methods The authors compared 51 patients undergoing staged bilateral TKA who received TXA (2 g; subjects) with 70 who did not (controls). There were no significant differences between the groups in terms of demographics or preoperative Hb. For each TKA, 1 g of TXA was administered intravenously 15 minutes before incision and 1 g was administered intravenously at tourniquet release. Blood loss, Hb levels, and transfusions were recorded. Statistical analyses were performed using computer software. Significance was set at 0.05. Results Subjects had a significantly lower (p < 0.001) mean (±SD) blood loss (373.8 ± 264.6 mL vs. 871.6 ± 457.7 mL), significantly higher (p < 0.005) Hb levels on Postoperative Days 1 and 2, and a significantly lower (p < 0.001) mean (±SD) number of transfused allogenic blood units (0.60 ± 0.84 units vs. 1.53 ± 1.30 units). Conclusions TXA reduces blood loss, improves postoperative Hb, and decreases the allogenic blood transfusion requirements for patients undergoing bilateral staged TKA. TXA is an option for patients choosing bilateral staged TKA to decrease the risks associated with blood transfusion or when autologous blood is not available.