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Tranexamic acid controlled blood loss in single-stage bilateral TKA
Dhillon M. Indian J Orthop. 2011;45:148-152.
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Tranexamic acid reduced total blood loss and decreased allogenic blood transfusion requirements in patients undergoing single-stage bilateral total knee arthroplasty, according to results of a case control study.
“Tranexamic acid (TEA) reduces blood loss and red cell transfusions in patients undergoing unilateral total knee arthroplasty (TKA),” wrote Mandeep S. Dhillon, MBBS, MS (Ortho), MNAMS, and colleagues at the Postgraduate Institute of Medical Education and Research in Chandigarh, India. “However, there is not much literature regarding the use of TEA in patients undergoing bilateral TKA in a single stage, and the protocols for administration of TEA in such patients are ill-defined.”
The researchers performed a case control study that assessed how TEA affected postoperative hemoglobin (Hb), total drain output and the number of blood units transfused. The study included 52 patients undergoing single-stage, bilateral TKA and 56 matched controls who did not receive TEA. The researchers administered two 10 mg/kg doses of TEA to patients in the study group via slow intravenous infusion. They gave the first dose just before releasing the tourniquet on the first knee. They administered the second dose 3 hours later.
The patients who received TEA had a statistically significant reduction in the total drain output and allogenic blood transfusion requirement. The postoperative Hb and Hb at discharge were lower in the control group; this result was statistically significant, the authors wrote.
Blood management for total joint arthroplasty is a continuing problem that the orthopedic community has not satisfactorily addressed. Most hospitals and surgeons do not have a satisfactory blood management program. Our Marshall Steele registry of more than 65 hospitals demonstrates a huge range between 6% and 62% in the use of allogenic blood transfusions after joint replacements. Allogenic blood continues to have many risks to patients. MedPar data shows additional hospital costs of $2,000 to $3,000 in patients who have a transfusion.
These authors have shown the benefit of tranexamic acid in reducing blood loss and allogenic transfusions after bilateral total knee replacement. Other authors have shown similar results in unilateral total hip and knee arthroplasty. Concerns have been thrombosis and allergic reactions. It is an extremely cost-effective method that is not commonly used today by orthopedic surgeons.
Orthopedic surgeons and their hospitals need to develop comprehensive blood management programs to reduce both blood loss and transfusions. One of the key strategies that should be evaluated is the appropriate use of tranexamic acid both for its safety and its cost-effectiveness. More surgeons are using it and, I believe that in the future, we will see a much broader use of tranexamic acid in orthopedic surgery.
– Marshall Steele MD
Orthopedic Surgeon
CEO Marshall Steele & Associates