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VOLUME 3 , ISSUE 2 ( July-December, 2018 ) > List of Articles


Efficacy and Safety of Tranexamic Acid in Total Knee Replacement Surgeries: A Randomized Control Trial

Madhavi Buddhi, Disha Kapadia

Keywords : Blood loss, Blood transfusion, Total knee replacement, Tranexamic acid

Citation Information : Buddhi M, Kapadia D. Efficacy and Safety of Tranexamic Acid in Total Knee Replacement Surgeries: A Randomized Control Trial. Res Inno Anesth 2018; 3 (2):37-40.

DOI: 10.5005/jp-journals-10049-0048

License: CC BY-NC 4.0

Published Online: 01-09-2019

Copyright Statement:  Copyright © 2018; The Author(s).


Context: Bleeding is of utmost concern in major orthopedic operations like total knee replacement, total hip replacement, and spine surgeries. Strategies to reduce blood loss must be employed to reduce allogeneic blood transfusion. Tranexamic acid (TAX) is an inexpensive synthetic derivative of the amino acid lysine. By attaching to lysine binding sites on plasminogen molecules it forms tranexamic acid–plasmin complex which has weaker fibrinolytic properties than plasmin alone. It also exhibits clot stabilizing and anti-inflammatory properties. When administered to surgical patients it can reduce blood loss and thus decrease transfusion requirements. Aim: This is a study to evaluate the efficacy and safety of tranexamic acid in reducing blood loss and need of postoperative blood transfusions following unilateral total knee replacement surgery in a tertiary care teaching hospital. Materials and methods: Sixty patients,18–70 years, American Society of Anesthesiology (ASA) statuses I and II undergoing unilateral total knee replacement under combined spinal-epidural anesthesia were enrolled in this prospective, randomized, double-blind study. Thirty patients each were randomly assigned to group T (TAX) and group C (control). Group T received intravenous tranexamic acid 10 mg/kg before tourniquet inflation followed by its infusion at 1 mg/kg/hour till skin closure. Group C received a similar amount of normal saline and served as the control group. The demographic data, duration of surgery, intraoperative vital parameters, intraoperative and postoperative blood loss, postoperative hemoglobin levels, quantity of blood transfusion required and a number of patients requiring blood transfusions and risk of the thromboembolic phenomenon were studied. Results: The mean (±SD) total blood loss was lower in the group receiving tranexamic acid (306.96 ± 75.23 mL) than in control group (543 ± 163.36 mL) which amounted to 43.47% less blood loss in the group receiving tranexamic acid. On an average control group required six times more blood transfusion than tranexamic acid group. Conclusion: Use of intravenous tranexamic acid is an effective and safe method to decrease blood loss in surgeries on the bone like total knee replacement.

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  1. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med 2007;356:2301-2311.
  2. Sculco TP. Global blood management in orthopedic surgery. Clin Orthop Relat Res 1998;357:43-49.
  3. Zimmerman LH. Causes and consequences of critical bleeding and mechanism of blood coagulation. Pharmacotherapy 2007;27:45S-56S.
  4. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty. A prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg [Br] 1996; 78-B:434-440.
  5. Vera-Llonch M. Clinical and economic consequences of bleeding following major orthopedic surgery. Thrombosis Research 2006;117:569-577.
  6. Lozano C. Tranexamic acid reduces allogenic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion 2005;45:1302-1307.
  7. Melanie J Maxwell, Mathew JA Wilson. Complications of blood transfusion. Continuing Education in Anaesthesia Critical Care & Pain, 2006;6(6):1:25-229.
  8. Eriksson BI, Eriksson E, Risberg B. Impaired fibrinolysis and postoperative thromboembolism in orthopaedic patients. Thromb Res 1991;62:55-64.
  9. Kakar PN, Gupta N, Govil P, et al. Efficacy and Safety of tranexamic Acid in Control of Bleeding Following TKR. Indian J Anaesth 2009;53:667-671.
  10. Almeida MD, Albuquerque RP, Palhares GM, et al. Evaluation of the use of tranexamic acid in total knee arthroplasty. Rev Bras Ortop 2018;53(6):761-767. ISSN0102-3616
  11. Vijay BS, Bedi V, Mitra S, et al. Role of Tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries. Saudi J Anaesth 2013;7(1);29-32.
  12. Danninger T, Stavros G. Memtsoudis Tranexamic acid and orthopaedic surgery-the search for the holy grail of blood conservation. Ann Transl Med 2015;3(6);77.
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