Effect of Multiple Doses of Intravenous Tranexamic Acid on Perioperative Blood Loss in Total Knee Arthroplasty: A Randomized Controlled Study

Autor: Bing‐xin Kang, Yu‐lin Li, Hui Xu, Chen‐xin Gao, Sheng Zhong, Jing Zhang, Jun Xie, Song‐tao Sun, Xi‐rui Xu, Chi Zhao, Ying‐hui Ma, Wei‐tao Zhai, Lian‐bo Xiao, Xiao‐xue Hu
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Orthopaedic Surgery, Vol 13, Iss 1, Pp 126-133 (2021)
Druh dokumentu: article
ISSN: 1757-7861
1757-7853
DOI: 10.1111/os.12850
Popis: Objective To identify the efficacy and safety of multiple doses of intravenous tranexamic acid (IV‐TXA) following primary total knee arthroplasty (TKA) with a tourniquet. Methods This is a single‐blind randomized controlled study that recruited osteoarthritis patients who had undergone primary unilateral TKA from May 2019 to May 2020 at our medical center. A total of 300 patients were randomly divided into three groups to receive: one dose (1 g) of IV‐TXA before skin incision combined with one dose (1.5 g) of intra‐articular tranexamic acid（IA‐TXA) followed by a single dose of IV‐TXA (1 g) for 3 h (group A); two doses of IV‐TXA (1 g) for 3 and 6 h (group B); or three doses of IV‐TXA (1 g) for 3, 6, and 12 h (group C) postoperatively. TKA with a tourniquet was performed by the same surgical team. The primary outcomes were total blood cell loss (TBL), hidden blood loss (HBL), maximum hemoglobin (Hb) drop, and transfusion rate. Secondary outcomes were levels of C‐reactive protein (CRP) and D‐dimer, and the incidence of postoperative complications. One‐way analysis of variance, subgroup analysis, and multivariate correlation analysis were used to calculate the differences among the three groups. Results The study included 56 male and 244 female patients aged 60–80 years. The mean TBL, the mean HBL, and the maximum Hb drop in group C (471.2 ± 190.6 mL, 428.4 ± 190.3 mL, and 21.2 ± 3.8 g/L, respectively) were significantly lower than those in groups B (563.4 ± 224.6 mL, P = 0.030; 519.9 ± 226.4 mL, P = 0.033; and 23.2 ± 4.1 g/L, P = 0.001, respectively), and A (651.6 ± 254.1 mL, P 0.05). In addition, there were positive correlations between the HBL and the tourniquet inflation time (r = 0.844, P
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