Reducing transfusion requirements following total knee arthroplasty: effectiveness of a double infusion of tranexamic acid

C. Legnani, G. Oriani, F. Parente, A. Ventura

IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy. claudio.legnani@grupposandonato.it

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• Pharmacology

OBJECTIVE: Blood loss following joint replacement surgery represents a relevant issue for orthopedic surgeons. The use of tranexamic acid (TXA) to reduce transfusion requirements has become mainstream. However, consensus about the starting time, methods, or volume of usage of TXA in joint replacement surgery has yet to be found. A retrospective study was conducted comparing pre- and post-operative infusion of TXA 15 mg/kg to a single pre-operative infusion.

PATIENTS AND METHODS: 291 patients undergoing TKA were retrospectively reviewed. 109 received a single pre-operative dose of 15 mg/ kg TXA (single dose, SD group), 182 received a single pre- operative dose of 15 mg/ kg TXA followed by a second post-operative dose of 15 mg/kg TXA (double dose, DD group). The primary outcome was blood loss calculated from haematological values and perioperative transfusions. Secondary outcomes included the occurrence of major complications within the first postoperative year.

RESULTS: None of the patients reported adverse events. Blood transfusions were administered to 63 patients (13.5%) in the SD and 36 in the DD group (5.7%). Significant difference between the groups was observed (p < 0.005). No significant difference between the two groups was found concerning mean blood loss in drainage after the 24th hour and postoperative hemoglobin values (p = n.s.).

CONCLUSIONS: The study demonstrated that TXA possesses a good safety profile. In addition, pre- and post-operative infusion of TXA 15 mg/kg is more effective compared to single pre-operative infusion in reducing need for transfusion requirements.

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