Efficacy And Safety Analysis Of Multiple-dose And Single-dose Of Tranexamic Acid In Total Knee Arthroplasty During Perioperative Period

Objective To compare the efficacy and safety of single-dose versus multiple-dose of perioperative tranexamic acid(TXA)use for total knee arthroplasty(TKA)patients.Methods Patients who received TKA from August 2016 to December 2016 in our department were enrolled retrospectively.From August 2016 to October 2016,all TKA patients received intravenous TXA(1.5 g)infusion 30 minutes prior to surgery;from November 2016 to December 2016,this single-dose regimen was modified to multiple-dose: 1.5 g TXA intravenous infusion 30 minutes before surgery,1 g TXA local injection before wound closure,and 1 g TXA intravenous infusion at 3,12,24,48,and 72 hours post-operatively.Parameters reflecting blood loss(total blood loss volumes,Hidden blood loss,the maximum hemoglobin(Hb)drop,postoperative draining,transfusion rates),hyper-coagulative state(coagulation functions,and the frequencies of deep vein thrombosis(DVT),pulmonary embolism(PE)),and inflammatory markers(C reactive protein(CRP)and erythrocyte sedimentation rate(ESR))were collected,calculated and compared between the two groups.Results The multiple-dose TXA group: hidden blood loss was(309.65±42.67)ml(499.56±244.2)ml,the maximum Hb drop was(15.67± 8.94)g/L,total blood loss was(499.56±244.2)ml,postoperative draining(46.87±12.31)ml which were significantly lower than their single-dose counterparts(P<0.001).Inflammatory markers(CRP and ESR)were significantly less at each post-operative time point in multiple-dose patients.There was no significant difference in the incidence of blood clotting,blood transfusion,deep venous thrombosis and pulmonary embolism,and between single use and multiple use.Compared with the single use of tranexamic acid group,the use of tranexamic acid in patients with C-reactive protein,erythrocyte sedimentation rate in the first 1,3,5 days were lower than the single use of patients.Conclusions Multiple-dose TXA regimen is an effective and safe method for TKA patients.Compared to single-dose protocol,it can further decrease blood loss volume and reduce post-operative inflammatory reaction without increasing DVT/PE risk.