Effects Of Tranexamic Acid And Different Anticoagulants On Blood Loss Under TKA Concept Of Fast Recovery

Objective:With the aging of the population,the demand for Total Knee Arthroplasty(TKA)as the final treatment for knee osteoarthritis is increasing,while the knee replacement surgery is more traumatic,hemorrhagic,and painful.affect the patient’s postoperative recovery.The concept of enhanced recovery after surgery(ERAS)optimizes the perioperative process of TKA through an evidence-based approach and a multidisciplinary approach.Among them,blood management is one of the cornerstones of ERAS.It optimizes the bleeding management of patients through various modes,and ultimately achieves the purpose of reducing surgical complications and promoting patient recovery.In this paper,by exploring the effects of tranexamic acid and different anticoagulants on perioperative blood loss in total knee arthroplasty,this paper provides ideas for achieving a balance between the use of antifibrinolytics and anticoagulants in the perioperative period of TKA.Methods:A retrospective analysis method was used to include 158 patients with knee osteoarthritis who underwent initial total knee arthroplasty from October 2014 to October 2019 and met the criteria.According to different tranexamic acid injection methods and postoperative use Different anticoagulants were divided into four groups:group A:intraoperative intravenous tranexamic acid+postoperative rivaroxaban anticoagulation;group B:intraoperative intravenous tranexamic acid+postoperative enoxaparin anticoagulation;Group C:intraoperative intravenous+local injection of tranexamic acid+postoperative rivaroxaban anticoagulation;group D:intraoperative intravenous+local injection of tranexamic acid+postoperative enoxaparin anticoagulation.The preoperative preparation,intraoperative and postoperative treatment of patients in each group were the same.Results:1.There was no significant difference in preoperative general data and intraoperative conditions among the four groups(P>0.05);2.Combined use of tranexamic acid could further reduce the total blood loss,overt blood loss,blood transfusion rate and plasma D2 Aggregate(P<0.05);3.Postoperative anticoagulation with rivaroxaban,the amount of blood loss,blood transfusion rate and the incidence of perioperative adverse events were comparable to enoxaparin.Conclusion:The application of intravenous tranexamic acid combined with local injection during TKA can further effectively reduce the blood loss、transfusion rate and Plasma D dimer during the perioperative period.Rivaroxaban or enoxaparin is used for anticoagulation after the operation,there was no significant difference in the blood loss and perioperative adverse events.