Effectiveness of a standard protocol for tranexamic acid administration in total hip and knee arthroplasty – does it make a difference?

  • Dr. Ram Sudhan S Junior Consultant, Department of Orthopaedics, Sunrise Hospital, Changaramukulam, Kerala, India
  • Dr. Srinivas Karthick Junior Consultant, Department of Orthopaedics, Medical Trust Hospital, Ernakulam, Kerala, India
  • Dr. Vijetha Nagendra Senior Registrar, Department of Neuroanaesthesia and Neurocritical care, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka, India
  • Dr. Jithesh Asokan Consultant, Department of Anaesthesia, Medical Trust Hospital, Ernakulam, Kerala, India
  • Dr. Vinod George Associate Consultant, Department of Orthopaedics, Medical Trust Hospital, Ernakulam, Kerala, India
  • Dr. Jacob J Consultant, Department of Orthopaedics, Medical Trust Hospital, Ernakulam, Kerala, India
Keywords: Total Knee Arthroplasty, Total Hip Arthroplasty, Tranexamic Acid

Abstract

Background: Intraoperative blood loss plays a key role in the outcome of any surgery and is most important during the immediate post-operative period in the management, for both the operating surgeon and the anesthetist. The present study compares postoperative hemoglobin decrease and blood transfusion requirements in total knee and hip arthroplasty with and without standardized perioperative tranexamic acid infusion.

Methods: This is a prospective randomized controlled study done on 41 patients undergoing a major joint replacement (total knee and hip arthroplasty) in the south Indian population in a single center. The primary aim of the study was to prove the efficiency of standardized tranexamic acid administration in reducing blood loss and need for blood transfusion in total knee and hip arthroplasty by comparing postoperative hemoglobin levels, peri-operative hemoglobin drop and frequency of blood transfusion in 2 groups one receiving and the other not receiving tranexamic acid during the peri-operative period.

Results: The mean pre-operative hemoglobin in the tranexamic acid group was 13.45 and in the control group was 13.0 with a p-value of 0.267, The mean hemoglobin level as on a postoperative day 1 in the tranexamic acid group was 12.32 and in the control group was 10.78 with p-value <0.001. The mean post-op hemoglobin levels on POD 3 in the tranexamic acid group were 11.75 and in Control group was 9.31 with p-value <0.001. The hemoglobin drop in the tranexamic acid group from pre-op to POD 3 was 1.7 mg/dl whereas in the control group the hemoglobin drop from pre-op to Pod 3 was 3.69 mg/dl which was more than double when compared to the tranexamic acid group. Out of 20 patients in the control group 3 patients, one patient who underwent total knee arthroplasty and two patients who underwent Total hip arthroplasty needed 1 unit of blood transfusion postoperatively.

Conclusion: The use of standardized Tranexamic acid infusion during the perioperative period of Total Hip and Knee Arthroplasty reduced the perioperative blood loss which was evident by high mean postoperative hemoglobin levels and low mean postoperative hemoglobin drop and decreased need for blood transfusion in Tranexamic acid group when compared to the control group.

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References

Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, et al. Femoral Nerve Block Improves Analgesia Outcomes after Total Knee ArthroplastyA Meta-analysis of Randomized Controlled Trials. Anesthesiology. 2010;113(5):1144-1162. doi: https://doi.org/10.1097/aln.0b013e3181f4b18.

Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, et al. Effect of anemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348(9034):1055-1060.

Cardone D, Klein AA. Perioperative blood conservation. Eur J Anaesthesiol. 2009;26(9):722-729. doi: https://doi.org/10.1097/eja.0b013e32832c5280.

Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009;91(6):776-783. doi: https://doi.org/10.1302/0301-620x.91b6.22393.

Bolton Maggs PH, Cohen H. Serious Hazards of Transfusion (SHOT) haemovigilance and progress are improving transfusion safety. Br J Hematol. 2013;163(3):303-314. doi: https://doi.org/10.1111/bjh.12547.

Frisch NB, Wessell NM, Charters MA, Yu S, Jeffries JJ, Silverton CD. Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty. 2014;29(9):189-192. doi: https://doi.org/10.1016/j.arth.2014.03.048.

Hallstrom B, Singal B, Cowen ME, Roberts KC, Hughes RE. The Michigan experience with safety and effectiveness of tranexamic acid use in hip and knee arthroplasty. J Bone Joint Surg. 2016;98(19):1646-1645.

Shore-Lesserson L, Reich DL, Vela-Cantos F, Ammar T, Ergin MA. Tranexamic acid reduces transfusions and mediastinal drainage in repeat cardiac surgery. Anesth Analg. 1996;83(1):18-26.

Benoni G, Fredin HA. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty. Bone Joint J. 1996;78(3):434-440.

Molloy DO, Archbold HA, Ogonda L, McConway J, Wilson RK, Beverland DE. Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement. Bone Joint J. 2007;89(3):306-309.

Ekbäck G, Axelsson K, Ryttberg L, Edlund B, Kjellberg J, Weckström J, et al. Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg. 2000;91(5):1124-1130.

Niskanen RO, Korkala OL. Tranexamic acid reduces blood loss in cemented hip arthroplasty: a randomized, double-blind study of 39 patients with osteoarthritis. Acta Orthopaedica. 2005;76(6):829-832.

Husted H, Blønd L, Sonne-Holm S, Holm G, Jacobsen T, Gebuhr P. Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty A prospective randomized double-blind study in 40 patients. Acta Orthopaedica Scandinavica. 2003;74(6):665-669.

Hiippala S, Strid L, Wennerstrand M, Arvela V, Mäntylä S, Ylinen J, Niemelä H. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. BJA: Br J Anaesth. 1995;74(5):534-537.

Johansson T, Pettersson LG, Lisander B. Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop. 2005;76(3):314-319.

Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion. 2008;48(3):519-525. doi: https://doi.org/10.1111/j.1537-2995.2007.01564.x.

Zufferey PJ, Miquet M, Quenet S, Martin P, Adam P, Albaladejo P, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anesth. 2009;104(1):23-30. doi: https://doi.org/10.1093/bja/aep314.

Alshryda S, Mason J, Vaghela M, Sarda P, Nargol A, Maheswaran S, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). J Bone Joint Surg Am. 2013;95(21):1961-1968. doi: https://doi.org/10.2106/jbjs.l.00907.

Wei Z, Liu M. The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty: a metaanalysis of 2720 cases. Transfusion Med. 2015;25(3):151-162. doi: https://doi.org/10.1111/tme.12212.

Watts CD, Houdek MT, Sems SA, Cross WW, Pagnano MW. Tranexamic Acid Safely Reduced Blood Loss in Hemi-and Total Hip Arthroplasty for Acute Femoral Neck Fracture: A Randomized Clinical Trial. J Orthop Trauma. 2017;31(7):345-351. doi: https://doi.org/10.1097/bot.0000000000000837.

Published
2020-04-30
How to Cite
Sudhan. S, R., Karthick, S., Nagendra, V., Asokan, J., George, V., & J, J. (2020). Effectiveness of a standard protocol for tranexamic acid administration in total hip and knee arthroplasty – does it make a difference?. Surgical Update: International Journal of Surgery and Orthopedics, 6(2), 121-126. https://doi.org/10.17511/ijoso.2020.i02.09
Section
Original Article