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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(02): 320-325
DOI: 10.1055/s-0042-1757958
Artigo Original
Joelho

Comparison of Blood Loss with the Use of Intravenous and Intraarticular Tranexamic Acid Versus Isolated Intraarticular in Primary Knee Arthroplasty[*]

Article in several languages: português | English
Elemar da Silva Resch 
1   Departamento de Ortopedia e Traumatologia, Hospital Universitário de Santa Maria, Santa Maria, RS, Brasil
,
Leandro Silvestro Lemos 
2   Departamento de Ortopedia e Traumatologia, Clínica Millenarium Multi Especialidades, Porto Alegre, RS, Brasil
,
José Salvador Pantoja dos Santos 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
,
João Fernando Argento Pozzi 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
,
Ewerton Renato Konkevicz 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
› Author Affiliations

Financial Support There was no financial support from public, commercial, or non-profit sources.
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Abstract

Objective The objective of this work is to compare blood loss during primary knee arthroplasty with the use of intravenous and intraarticular (IV + IA) tranexamic acid versus intraarticular (IA) tranexamic acid alone.

Methods This is a randomized, double-blind clinical trial. Patients with indication for primary total knee arthroplasty were recruited in a specialized clinic, where they were operated by the same surgeon, always using the same surgical technique. Thirty patients were allocated in the IV + IA tranexamic acid group and 30 patients in the IA tranexamic acid group, according to randomization. Blood loss was compared through hemoglobin, hematocrit, drain volume, and blood loss estimation (Gross and Nadler calculus).

Results After collection, data from 40 patients were analyzed, 22 in the IA group and 18 in the IV + IA group. There were 20 losses due to collection error. Between groups IA and IV + IA, there were no significant differences in 24 hours between hemoglobin levels (10.56 vs. 10.65 g/dL; F1.39 = 0.63, p = 0.429), erythrocyte (3.63 vs. 3.73 million/mm3; F1.39 = 0.90, p = 0.346); hematocrit (32.14 vs. 32.60%; F1.39 = 1.39, p = 0.240); drainage volume (197.0 vs. 173.6 mL; F1.39 = 3.38 p = 0.069); and estimated blood loss (1,002.5 vs. 980.1; F1.39 = 0.09, p = 0.770). The same occurred in comparisons conducted after 48 hours postoperatively. Time was a significant factor for the change of all outcome variables. However, the treatment did not modify the effect of time on these outcomes. No individual presented any thromboembolic event during the work period.

Conclusions The use of IV + IA tranexamic acid showed no advantage in reducing blood loss when compared to the use of IA tranexamic acid alone in primary knee arthroplasties. This technique proved to be safe, since no thromboembolic event occurred during the development of the work.

Keywords

arthroplasty, replacement, knee - tranexamic acid - blood loss

* Work developed at Regina Hospital, Novo Hamburgo, RS, Brazil.




Publication History

Received: 29 December 2021

Accepted: 12 September 2022

Article published online:
25 May 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Nielsen CS, Jans Ø, Ørsnes T, Foss NB, Troelsen A, Husted H. Combined Intra-Articular and Intravenous Tranexamic Acid Reduces Blood Loss in Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial. J Bone Joint Surg Am 2016; 98 (10) 835-841
    Search in Google Scholar
  • 2 Maempel JF, Wickramasinghe NR, Clement ND, Brenkel IJ, Walmsley PJ. The pre-operative levels of haemoglobin in the blood can be used to predict the risk of allogenic blood transfusion after total knee arthroplasty. Bone Joint J 2016; 98-B (04) 490-497
    Search in Google Scholar
  • 3 Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG, Parvizi J. Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am 2013; 95 (19) 1777-1783
    Search in Google Scholar
  • 4 Panni AS, Cerciello S, Vasso M, Del Regno C. Knee flexion after total knee arthroplasty reduces blood loss. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1859-1864
    Search in Google Scholar
  • 5 da Rocha VM, de Barros AG, Naves CD. et al. Use of tranexamic acid for controlling bleeding in thoracolumbar scoliosis surgery with posterior instrumentation. Rev Bras Ortop 2015; 50 (02) 226-231
    Search in Google Scholar
  • 6 McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs 2012; 72 (05) 585-617
    Search in Google Scholar
  • 7 Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 2012; 94 (13) 1153-1159
    Search in Google Scholar
  • 8 Ishida K, Tsumura N, Kitagawa A. et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 2011; 35 (11) 1639-1645
    Search in Google Scholar
  • 9 Sabbag OD, Abdel MP, Amundson AW, Larson DR, Pagnano MW. Tranexamic Acid Was Safe in Arthroplasty Patients With a History of Venous Thromboembolism: A Matched Outcome Study. J Arthroplasty 2017; 32 (9S): S246-S250
    Search in Google Scholar
  • 10 Wong J, Abrishami A, El Beheiry H. et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 2010; 92 (15) 2503-2513
    Search in Google Scholar
  • 11 Alshryda S, Mason J, Vaghela M. et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). J Bone Joint Surg Am 2013; 95 (21) 1961-1968
    Search in Google Scholar
  • 12 Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial. J Bone Joint Surg Am 2014; 96 (23) 1937-1944
    Search in Google Scholar
  • 13 Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty 2014; 29 (08) 1528-1531
    Search in Google Scholar
  • 14 Sassoon A, Nam D, Jackups R, Johnson SR, Nunley RM, Barrack RL. Tranexamic acid: optimal blood loss management in surface replacement arthroplasty. Bone Joint J 2016; 98-B (02) 173-178
    Search in Google Scholar
  • 15 Almeida MDC, Albuquerque RPE, Palhares GM, Almeida JPC, Barretto JM, Cavanellas N. Evaluation of the use of tranexamic acid in total knee arthroplasty. Rev Bras Ortop 2018; 53 (06) 761-767
    Search in Google Scholar
  • 16 Fillingham YA, Ramkumar DB, Jevsevar DS. et al. The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis. J Arthroplasty 2018; 33 (10) 3090-3098.e1
    Search in Google Scholar
  • 17 Goes RFA, Silva AF, Lyra FS, Lourdes FB, Palma IM, Cobra HAAB. et al. Estudo prospectivo randomizado após uso de dreno na artroplastia total do joelho com implante. Rev Bras Ortop 2013; 48 (03) 257-262
    Search in Google Scholar
  • 18 Andrade MAP, Campos TVO, Silva BFA, Assis ME, Boechat LC, Biondi LF. et al. Avaliação prospectiva dos pacientes submetidos á artroplastia total de joelho com e sem colocação de dreno de sucção. Rev Bras Ortop 2010; 45 (06) 549-553
    Search in Google Scholar
  • 19 Leão MGS, Souza HAP, Ferreira YMC. Avaliação da perda sanguínea após a liberação precoce ou tardia da isquemia em pacientes submetidos à artroplastia total do joelho. Rev Bras Ortop 2013; 48 (02) 152-158
    Search in Google Scholar
  • 20 Mi B, Liu G, Zhou W. et al. Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2017; 137 (07) 997-1009
    Search in Google Scholar
  • 21 Zhang LK, Ma JX, Kuang MJ. et al. Comparison of oral versus intravenous application of tranexamic acid in total knee and hip arthroplasty: A systematic review and meta-analysis. Int J Surg 2017; 45: 77-84
    Search in Google Scholar
  • 22 Su EP, Su S. Strategies for reducing peri-operative blood loss in total knee arthroplasty. Bone Joint J 2016; 98-B (1, Suppl A) 98-100
    Search in Google Scholar
  • 23 Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 2004; 19 (03) 281-287
    Search in Google Scholar
  • 24 Ponnusamy KE, Kim TJ, Khanuja HS. Perioperative blood transfusions in orthopaedic surgery. J Bone Joint Surg Am 2014; 96 (21) 1836-1844
    Search in Google Scholar
  • 25 Aguilera X, Martinez-Zapata MJ, Bosch A. et al. Efficacy and safety of fibrin glue and tranexamic acid to prevent postoperative blood loss in total knee arthroplasty: a randomized controlled clinical trial. J Bone Joint Surg Am 2013; 95 (22) 2001-2007
    Search in Google Scholar
  • 26 Henry DA, Carless PA, Moxey AJ. et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2011; (01) CD001886
    Search in Google Scholar
  • 27 Zekcer A, Priori RD, Tieppo C, Silva RSD, Severino NR. Comparative study of topical vs. intravenous tranexamic acid regarding blood loss in total knee arthroplasty. Rev Bras Ortop 2017; 52 (05) 589-595
    Search in Google Scholar
  • 28 Wang D, Wang HY, Cao C. et al. Tranexamic acid in primary total knee arthroplasty without tourniquet: a randomized, controlled trial of oral versus intravenous versus topical administration. Sci Rep 2018; 8 (01) 13579
    Search in Google Scholar
  • 29 Zhang YM, Yang B, Sun XD, Zhang Z. Combined intravenous and intra-articular tranexamic acid administration in total knee arthroplasty for preventing blood loss and hyperfibrinolysis: A randomized controlled trial. [published correction appears in Medicine (Baltimore) 2019;98(12):e15000] Medicine (Baltimore) 2019; 98 (07) e14458
    Search in Google Scholar
  • 30 Souza Neto EP, Usandizaga G. Comparison of two doses of intra-articular tranexamic acid on postoperative bleeding in total knee arthroplasty: a randomized clinical trial. Braz J Anesthesiol 2020; 70 (04) 318-324
    Search in Google Scholar