J Knee Surg 2021; 34(07): 749-754
DOI: 10.1055/s-0039-1700805
Original Article

One Versus Two Doses of Intravenous Tranexamic Acid in Total Knee Arthroplasty

Ryan S. Charette
1   Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Jenna A. Bernstein
1   Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Matthew Sloan
1   Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Corbyn M. Nchako
2   Saint Louis University School of Medicine, Saint Louis, Missouri
,
Atul F. Kamath
1   Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Charles L. Nelson
1   Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
› Institutsangaben

Abstract

Tranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary TKA, and received one or two doses of intravenous TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay, rate of deep vein thrombosis or pulmonary embolism (DVT/PE), readmission and reoperation.

A total of 1,191 patients were included: 891 received one dose and 300 received two doses. There was no significant difference in rate of transfusion, deep vein thrombosis or pulmonary embolism (DVT/PE), blood volume loss, and reoperation. There was a significantly higher risk of readmission (6.7 vs. 2.4%, odds ratio [OR] 2.96, p < 0.001) and reoperation (2.0 vs. 0.6%, OR 3.61, p = 0.024) in patients receiving two doses. These findings were similar with subgroup analysis of patients receiving only aspirin prophylaxis.

In unilateral TKA, there is no difference in transfusion rate with one or two doses of perioperative TXA. There was no increased risk of thromboembolic events between groups, although the two-dose group had a higher rate of readmission and reoperation. Given the added cost without clear benefit, these findings may support administration of one rather than two doses of TXA during primary TKA.



Publikationsverlauf

Eingereicht: 20. September 2019

Angenommen: 23. September 2019

Artikel online veröffentlicht:
15. November 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
  • 2 Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 2008; 79 (02) 168-173
  • 3 Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 2000; 7 (03) 151-155
  • 4 Cushner FD, Friedman RJ. Blood loss in total knee arthroplasty. Clin Orthop Relat Res 1991; (269) 98-101
  • 5 Guo P, He Z, Wang Y. et al. Efficacy and safety of oral tranexamic acid in total knee arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97 (18) e0587
  • 6 Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 2009; 113 (15) 3406-3417
  • 7 Klein HG. Allogeneic transfusion risks in the surgical patient. Am J Surg 1995; 170 (6A, Suppl): 21S-26S
  • 8 Shander A, Hofmann A, Ozawa S, Theusinger OM, Gombotz H, Spahn DR. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion 2010; 50 (04) 753-765
  • 9 Georgiadis AG, Muh SJ, Silverton CD, Weir RM, Laker MW. A prospective double-blind placebo controlled trial of topical tranexamic acid in total knee arthroplasty. J Arthroplasty 2013; 28 (8, Suppl): 78-82
  • 10 Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 2013; 20 (05) 300-309
  • 11 MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty 2011; 26 (01) 24-28
  • 12 Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 2001; 83 (05) 702-705
  • 13 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 (03) 434-440
  • 14 Seol YJ, Seon JK, Lee SH. et al. Effect of tranexamic acid on blood loss and blood transfusion reduction after total knee arthroplasty. Knee Surg Relat Res 2016; 28 (03) 188-193
  • 15 Hallstrom B, Singal B, Cowen ME, Roberts KC, Hughes RE. The Michigan experience with safety and effectiveness of tranexamic acid use in hip and knee arthroplasty. J Bone Joint Surg Am 2016; 98 (19) 1646-1655
  • 16 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
  • 17 Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM. Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br 2011; 93 (12) 1577-1585
  • 18 Huang Z, Ma J, Shen B, Pei F. Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2014; 29 (12) 2342-2346
  • 19 Tuttle JR, Ritterman SA, Cassidy DB, Anazonwu WA, Froehlich JA, Rubin LE. Cost benefit analysis of topical tranexamic acid in primary total hip and knee arthroplasty. J Arthroplasty 2014; 29 (08) 1512-1515
  • 20 Gilbody J, Dhotar HS, Perruccio AV, Davey JR. Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty. J Arthroplasty 2014; 29 (04) 681-684
  • 21 Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty 2013; 28 (09) 1473-1476
  • 22 Fillingham YA, Ramkumar DB, Jevsevar DS. et al. Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty 2018; 33 (10) 3065-3069
  • 23 Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 2012; 470 (09) 2605-2612
  • 24 Lin PC, Hsu CH, Huang CC, Chen WS, Wang JW. The blood-saving effect of tranexamic acid in minimally invasive total knee replacement: is an additional pre-operative injection effective?. J Bone Joint Surg Br 2012; 94 (07) 932-936
  • 25 Sun Q, Yu X, Wu J, Ge W, Cai M, Li S. Efficacy of a single dose an additional dose of tranexamic acid in reduction of blood loss in total knee arthroplasty. J Arthroplasty 2017; 32 (07) 2108-2112
  • 26 Xie J, Ma J, Yao H, Yue C, Pei F. Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss after primary total knee arthroplasty without tourniquet: a randomized clinical trial. J Arthroplasty 2016; 31 (11) 2458-2464
  • 27 Gibon E, Courpied JP, Hamadouche M. Total joint replacement and blood loss: what is the best equation?. Int Orthop 2013; 37 (04) 735-739
  • 28 Wilde JM, Copp SN, McCauley JC, Bugbee WD. One dose of intravenous tranexamic acid is equivalent to two doses in total hip and knee arthroplasty. J Bone Joint Surg Am 2018; 100 (13) 1104-1109
  • 29 Tan J, Chen H, Liu Q, Chen C, Huang W. A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res 2013; 184 (02) 880-887
  • 30 Niskanen RO, Korkala OL. Tranexamic acid reduces blood loss in cemented hip arthroplasty: a randomized, double-blind study of 39 patients with osteoarthritis. Acta Orthop 2005; 76 (06) 829-832