Efficacy And Safety Of Combined Use Of Tranexamic Acid In Total Knee Arthroplasty

Objective:To investigate the efficacy and safety of tranexamic acid in reducing perioperative blood loss in patients with total knee arthroplasty.Methods:261 patients undergoing total knee arthroplasty from January 2020 to December 2021 were enrolled,including 61 males and 200 females,at the age of(68.0±7.1).Among them,85 cases received intravenous infusion of tranexamic acid 1 g before skin incision and when the incision was sutured(intravenous group);115 cases received intravenous infusion of tranexamic acid 1 g before skin incision,and 1 g of tranexamic acid was given intravenously when the incision was sutured after surgery(combined group);61 cases did not use tranexamic acid(blank group).Blood loss of the patients was recorded;blood laboratory data of the patients were collected after surgery;postoperative complications and blood transfusion were counted.All patients were followed up to 1 month after the operation.Results:Postoperative drainage:the intravenous group had less drainage on 1st day after surgery than the blank group(P<0.001),and the combined group had less drainage on 1st day after surgery than the blank group(P<0.001).The intravenous group had less drainage on 2nd day after surgery than the blank group(P<0.001),and the combined group had less drainage on 2nd day after surgery than the blank group(P<0.001).Total blood loss:the total blood loss in the intravenous group was less than that in the blank group(P<0.001),and the total blood loss in the combined group was less than that in the blank group(P<0.001).Occult blood loss:the occult blood loss in the intravenous group was less than that in the blank group(P<0.001),and the recessive blood loss in the combined group was less than that in the blank group(P<0.001).Transfusion rate:There was no significant difference in transfusion rate between intravenous group and combined group(P>0.05),the transfusion rate in intravenous group was lower than that in blank group(P<0.01),and the transfusion rate in combination group was lower than that in blank group(P<0.01).Incidence of venous thrombosis:There was no significant difference in the incidence of venous thrombosis between the three groups(P>0.05).Hemoglobin:the hemoglobin level on the 1st and 3rd postoperative days after surgery in the intravenous group was higher than in the blank group(P<0.001),and on the 1st and 3rd postoperative days in the combined group was higher than in the blank group(P<0.001).Platelet count:the platelet count on 1st day after surgery in the intravenous group was greater than that in the blank group(P<0.05),and the platelet count on 1st day after surgery in the combined group was greater than that in the blank group(P<0.05).WBC count:the WBC count on 1st day after surgery in the intravenous group was lower than that in the combined group(P<0.05),the WBC count on 1st day after surgery in the intravenous group was lower than that in the blank group(P<0.001),and the WBC count on 1st day after surgery in the combined group was lower than that in the blank group(P<0.01).C-reactive protein:the level of C-reactive protein on 1st day after surgery in the intravenous group was lower than that in the combined group(P<0.01),the level of C-reactive protein on 1st day after surgery in the intravenous group was lower than that in the blank group(P<0.001),and the level of C-reactive protein on 1st day after surgery in the combined group was lower than that in the blank group(P<0.01).ESR:the ESR on the 1 st postoperative day in the intravenous group was lower than that in the combined group(P<0.05),the ESR on the 1st postoperative day in the intravenous group was lower than that in the blank group(P<0.001),and the ESR on the 1st postoperative day in the combined group was lower than that in the blank group(P<0.01).Coagulation indexes:There was no significant difference in postoperative prothrombin time,partial prothrombin time and fibrinogen level between the three groups(P>0.05).Conclusion:(1)Tranexamic acid can reduce perioperative blood loss during total knee arthroplasty;(2)Tranexamic acid does not increase the incidence of thrombosis in patients with total knee replacement,and effectively reduces the rate of perioperative blood transfusion;(3)The use of tranexamic acid can reduce the postoperative inflammatory response of patients;(4)In total knee replacement,intravenous and intraarticular injection are effective ways to use tranexamic acid,and intra-articular injection does not have a synergistic effect.