Abstract
Introduction
The current study was conducted to evaluate the effect of different applications of tranexamic acid (TXA) on perioperative blood transfusion rate and postoperative pain in unilateral total knee arthroplasty.
Methods
This prospective study included a total of 102 patients undergoing unilateral total knee arthroplasty in our hospital from November 2017 to October 2019. On the basis of different TXA administration methods, these patients were randomly assigned to a surface treatment group (50 cases were treated with intraoperative spraying and drug-soaked gauze to cover the wound combined with local injection into the articular cavity) and control group (52 cases were given TXA by intravenous drip combined with local injection into the articular cavity) by random number table method. Clinical data were recorded and evaluated in the two groups. A total of five surgeons participated in the study.
Results
In the surface treatment group, the operation time, hospital stay, tourniquet time, and blood transfusion rate were significant lower compared with the control group, and there was no significant difference in the incision length between the two groups. Our results showed that intraoperative blood loss, postoperative drainage, postoperative blood loss, total blood loss, and the incidence of deep venous thrombosis in the surface treatment group were significantly lower than those in the control group. Our results demonstrated that the surface treatment group reported significantly lower degree of pain compared with the control group at 1 day and 3 days after the operation. However, 7 days after the operation, the degree of pain in the surface treatment group did not differ significantly from that in the control group. In addition, the results of blood coagulation indexes showed that the values of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), and hemoglobin (HGB) in the surface treatment group did not differ significantly from those in the control group before the operation (P > 0.05).
Conclusion
In terms of applications of TXA, the method of intraoperative spraying and drug-soaked gauze covering the wound combined with local injection into the articular cavity can reduce the amount of bleeding and the rate of blood transfusion, and alleviate the degree of pain with high safety profile.
Similar content being viewed by others
References
Wallace IJ, Worthington S, Felson DT, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci USA. 2017;114:9332–6.
Katchy AU, Njeze NR, Ezeofor S, et al. Geometrical analysis of the proximal femur and the clinical application in total hip replacement: a study of the Igbo population of south East Nigeria. Niger J Clin Pract. 2019;22:1728–36.
Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.
Yoshida K, Barr RJ, Galea-Soler S, et al. Reproducibility and diagnostic accuracy of Kellgren–Lawrence grading for osteoarthritis using radiographs and dual-energy X-ray absorptiometry images. J Clin Densitom. 2015;18:239–44.
Kim WJ, Park JS, Won SH, et al. Total hip arthroplasty in hereditary multiple exostoses with secondary osteoarthritis: a case report. Medicine. 2019;98:e18175.
Yaseen MK, Gorial FI. An observational descriptive cross sectional multicenter study of health related quality of life among Iraqi patients after total hip replacement. Ann Med Surg. 2012;2019(48):118–21.
Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion. 2005;45:1302–7.
Kawaguchi K, Kinoshita S, Ishikawa M, et al. Tranexamic acid-induced fixed drug eruption confirmed by the drug lymphocyte transformation test. Clin Case Rep. 2019;7:2074–5.
Faraoni D, Levy JH. Tranexamic acid for acute hemorrhage: when is enough evidence enough? Anesth Analg. 2019;129:1459–61.
Lopez-Hualda A, Dauder-Gallego C, Ferreno-Marquez D, et al. Efficacy and safety of topical tranexamic acid in knee arthroplasty. Med Clin. 2018;151:431–4.
Pan DQ, Chen LL, Sun B, et al. Effect of tranexamic acid combined flexion position of hip and knee on perioperative bleeding following unilateral total knee arthroplasty. Zhongguo Gu Shang. 2019;32:759–64.
Bi RB, Ji L, Wang XK. Effect analysis of multimode analgesia of parecoxib sodium during laparoscopic cholecystectomy. Zhonghua Yi Xue Za Zhi. 2013;93:2727–9.
Liu P, Guo WS, Zhang QD, et al. Efficacy and safety of compound betamethasone cocktail therapy in primary unilateral unicompartmental knee arthroplasty. Zhonghua Yi Xue Za Zhi. 2019;99:3100–4.
Rannou F, Pelletier JP, Martel-Pelletier J. Efficacy and safety of topical NSAIDs in the management of osteoarthritis: evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45:S18-21.
Kuo FC, Lin PY, Wang JW, et al. Intravenous tranexamic acid use in revision total joint arthroplasty: a meta-analysis. Drug Design Dev Ther. 2018;12:3163–70.
Tanaka N, Sakahashi H, Sato E, et al. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Jt Surg Br. 2001;83:702–5.
Wong J, Abrishami A, El Beheiry H, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Jt Surg Am. 2010;92:2503–13.
Hourlier H, Fennema P. Chemoprophylaxis without intra-articular wound drainage can replace autotransfusion in primary TKA. Orthopedics. 2011;34:154.
Jinwei X, Jun M, Pengde K, et al. Does tranexamic acid alter the risk of thromboembolism following primary total knee arthroplasty with sequential earlier anticoagulation? A large, single center, prospective cohort study of consecutive cases. Thromb Res. 2015;136:234–8.
Michael GR, Geoffrey HW, Hollis GP, et al. Effect of mechanical compression on the prevalence of proximal deep venous thrombosis as assessed by magnetic resonance venography. J Bone Joint Surg Am. 2002;84:1998–2004.
Arie M. Origin and natural history of deep vein thrombosis of the legs. Semin Vasc Med. 2005;5:65–74.
Clive K, Elie AA, Anthony JC, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e419S-e496S.
Acknowledgements
We thank the participants of the study.
Funding
No funding or sponsorship was received for this study or publication of this article. The Rapid Service Fee was funded by the authors.
Authorship
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Authorship Contributions
Xiaodong Zhang and Liang Wen contributed to the conception and design of the study; Deli Ma and Jiang Pan performed the experiments, collected and analyzed data; Xiaodong Zhang and Liang Wen wrote the manuscript; All authors reviewed and approved the final version of the manuscript.
Disclosures
Xiaodong Zhang, Deli Ma, Jiang Pan and Liang Wen have nothing to disclose.
Compliance with Ethics Guidelines
Informed consent was obtained from all patents before enrollment. This study protocol was approved by Beijing Chao-Yang Hospital. The work was performed in accordance with the Helsinki Declaration of 1964 and its later amendments.
Data Availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhang, X., Ma, D., Pan, J. et al. Effects of Different Applications of Tranexamic Acid on Perioperative Blood Transfusion Rate and Postoperative Pain in Unilateral Total Knee Arthroplasty. Adv Ther 38, 1143–1154 (2021). https://doi.org/10.1007/s12325-020-01596-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12325-020-01596-4