Transfusion and Haemostasis
Tranexamic acid reduces blood transfusion without increases in thrombotic complications in joint replacement surgery: 6AP2-6
Background and Goal of Study: The efficacy of prophylactic tranexamic acid (TXA) in knee arthroplasty (KA) has been widely demonstrated, based in a fibrinolytic effect of tourniquet. More controversial is the efficacy in hip arthroplasty (HA). Finally, de keystone in the use of TXA is thrombotic risk. The objectives of our study were firstly to evaluate the comparative efficacy of TXA in the two joint replacement surgeries and secondly the evaluation of thrombotic complications.
Materials and Methods: In a double blind prospective study patients scheduled for KA or HA were randomly assigned into two groups. In the group TXA, 10 mg/kg of antifibrinolytic drug was administer prophilactically and then repeated after 3 hours. In the control group, saline was given matching the protocol. For the evaluation of efficacy the amount of blood drained, calculated blood loss and allogenic transfusion was register. A complete ultrasound examination of limbs and a computed tomographic pulmonary angiography was done in all patients. A six-month review of medical records in the hospital and regional health registry completed the study. T-test was used for quantitative variables and Chi-square test for qualitative variables.
Results and Discussion: Forty-four patients were included: 22 patients were randomized to TXA (11 KA and 11HA) and 22 to placebo (11KA and 11 HA). Groups were similar in sex, age, preoperative haematocrit and coagulation parameters. Mean (SD) values in haemoglobin (Hb) reduction and transfusion are summarised below (table 1). Five patients had a thrombotic complication, but only one was clinically relevant. No more thrombotic complications were detected in the six month surveillance.
Conclusion(s): Tranexamic acid reduces transfusion requirements and blood losses in knee and hip arthroplasty, without differences in the efficacy between the two surgeries. Moreover we can affirm that the prophylactic use of tranexamic acid doesn't increase the risk for thrombotic complications.© 2012 European Society of Anaesthesiology