Publication: Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial
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Issued Date
2013
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Musculoskeletal Disorders. Vol. 14, (2013), 340
Suggested Citation
Paphon Sa-ngasoongsong, Siwadol Wongsak, Pongsthorn Chanplakorn, Patarawan Woratanarat, Supaporn Wechmongkolgorn, Bussanee Wibulpolprasert, Pornchai Mulpruek, Viroj Kawinwonggowit Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial. BMC Musculoskeletal Disorders. Vol. 14, (2013), 340. doi:10.1186/1471-2474-14-340 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/2701
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Title
Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial
Abstract
Background: Recently, a number of studies using intra-articular application of tranexamic acid (IA-TXA), with
different dosage and techniques, successfully reduced postoperative blood loss in total knee replacement (TKR).
However, best of our knowledge, the very low dose of IA-TXA with drain clamping technique in conventional TKR
has not been yet studied. This study aimed to evaluate the effectiveness and dose-response effect of two low-dose
IA-TXA regimens in conventional TKR on blood loss and blood transfusion reduction.
Methods: Between 2010 and 2011, a triple-blinded randomized controlled study was conducted in 135 patients
undergoing conventional TKR. The patients were allocated into three groups according to intra-articular solution
received: Control group (physiologic saline), TXA-250 group (TXA 250 mg), and TXA-500 group (TXA 500 mg). The
solution was injected after wound closure followed by drain clamping for 2 hours. Blood loss and transfusion were
recorded. Duplex ultrasound was performed. Functional outcome and complication were followed for one year.
Results: There were forty-five patients per groups. The mean total hemoglobin loss was 2.9 g/dL in control group
compared with 2.2 g/dL in both TXA groups (p > 0.001). Ten patients (22%, control), six patients (13%, TXA-250) and
none (TXA-500) required transfusion (p = 0.005). Thromboembolic events were detected in 7 patients (4 controls, 1
TXA-250, and 2 TXA-500). Functional outcome was non-significant difference between groups.
Conclusions: Combined low-dose IA-TXA, as 500 mg, with 2-hour clamp drain is effective for reducing postoperative
blood loss and transfusion in conventional TKR without significant difference in postoperative knee function or
complication.