The Impact Of Joint Application Of Tranexamic Acid On Postoperative Blood Loss In Total Knee Arthroplasty

Objective:It has been counted that approximately30%of the patients who take totalknee arthroplasty (TKA) are transfused1-3u blood in order to remit theclinical symptoms caused by post-operation blood loss. Tranexamic acid,a kind of synthetic drug, can avoid bleeding by antifibrinolysis. It hasbeen proved to avoid post-operation bleeding by intravenous infusion.Nevertheless, local application of tranexamic acid may be moreconductive to the management of patients, in the meantime makes thelocal drug concentration maximized in order to dismiss the risks andcomplications caused by drug venous absorption. This article purposes tostudy the impact of local application(intra-articular) of tranexamic acid ofpost-operation blood loss and transfusion, puts the patients who takeunilateral TKA in department of orthopaedics, China-Japan UnionHospital, Jilin University from2012.1-12in study, applies localintra-articular injection of tranexamic acid, conduct a double-blind,randomized and placebo-controlled clinical trial.Method:We screened the patients who take first-time TKA in China-UnionHospital, eliminated the patients who are allergic of tranexamic acid,using warfarin or heparin, haveing the history of hemophilia, surferingDVT or pulmonary embolism, renal insufficiency and pregnancy. Put the proportion of the patients who take transfusion, blood loss volume,transfusion volume, the changes of Hb and Hct concentration in thesecond day post-operation, hospitalization time, knee function, kneesociety score(KSS), complications into statistics.The screened patients were operated with general anesthesia, lie supineon the operating table, sterilized, draped. Thigh tourniquet are charged to350mmHg. The screened patients had not accepted patellar resurfacing.Choose medial patellofemoral incision, use two bags of40g bone cementduring operation, place drainage tube after operation and clip the drainagetube after releasing tourniquet. For experimental group(Group A),dissolve2g tranexamic acid to50ml0.9%NS, for control group (Group B)select50ml0.9%NS as placebo. The two group of solution are the samein color and character. Spill the two group of solution in joint cavity afterTKA, suture the incision, band the incision by elastic bandage, thenrelease the tourniquet.Use the statistical software SPSS20.0, continuous variable choose ttesting, classified variable choose independentχ2testing. The statisticsresults show P <0.05, suggesting a significant difference.Results:1.6cases of group A (1.3%),18cases of group B(16.7%) aretransfused, absolute risk and complication are reduced by15.4%(p=0.001) 2. Blood loss: Average drainage volume: group A231ml, groupB570ml(p=0.0002); calculate the whole body blood loss, group A769ml,group B2310ml(p<0.0001)3. Hb and Hct value after operation: the test result at the first day afteroperation show Hb value of group A is significantly higher than group B,Hct value perfume similar trend as well(p<0.0001).4. Average hospitalization time: group A is one day shorter than group B,the3-months follow-up of KSS shows no significant difference(p=0.613and0.887).5. Post-operative complications:3cases in group A(1DVT,2pulmonaryinfection),4cases of group B (1periprosthetic fracture,2superficialinfection,1DVT(p=0.01))Conclusion:The local application of tranexamic acid could be a effective measure toreduce TKA post-operative blood loss, anemia, transfusion. And couldeffectively avoid the risks and complications caused by venousapplication of tranexamic acid...