Volume 24, Issue 106, November - December, 2020

Comparison of intravenous, oral and intra-articular effects of tranexamic acid on reducing postoperative knee replacement bleeding

Hoseinali Hadi¹, Shamim Valibeik², Shirin Pazouki³, Siamak Rakei⁴, Alireza Kamali^3♦

¹Department of Orthopedics, Arak University of Medical Sciences, Arak, Iran
²Student Research Committee, Arak University of Medical Sciences, Arak, Iran
³Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
⁴Department of Surgery, Arak University of Medical Sciences, Arak, Iran

^♦Corresponding author
Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran; Email: dralirezakamali875@gmail.com

ABSTRACT

Introduction: Complete knee replacement (Total knee) is one of the greatest surgical skills of the last century. Bleeding during and after this surgery is a major concern in selective knee replacement surgery. One of the most effective ways to reduce bleeding in this procedure is the use of antifibrinolytic drugs, especially tranexamic acid. However, the best use of this drug needs further investigation. Therefore, in this study, we compared the effect of intravenous, oral and Intra-articular tranexamic acid. Materials and Methods: This study was a randomized, single-blind clinical trial with 135 patients undergoing knee replacement, referred to Amir al- Momenin Hospital and Qods Hospital, Arak, Iran, during 2019-2020. Participants were divided into 3 groups of 45 patients (intravenous tranexamic acid group, oral tranexamic acid group and Intra-articular tranexamic acid group). The mean of postoperative bleeding (up to 48 hours), mean return to operation room, mean hemoglobin in arthroplasty candidates, 8 hours and 48 hours after surgery, mean hospital stay and mean thromboembolic complications were compared. Results: The mean intraoperative bleeding was lower in the intravenous group than in the other two groups and in the Intra-articular group was lower than in the oral group (P = 0.01), but there was no significant difference (P = 0.4) in the mean bleeding after 72 hours. There was no significant difference in mean hemoglobin preoperatively, 8 hours and 48 hours postoperatively (P = 0.3, P = 0.7, P = 0.6). Also, there was no significant difference between the three groups in terms of mean hospital stay (P> 0.05 and P = 0.6). No postoperative or transfusion complications were seen in any of the groups, so no significant difference was observed (P> 0.05). Conclusion: Mean intraoperative bleeding was lower in the intravenous group than in the other two groups. The rate of postoperative bleeding, mean hemoglobin level decrease up to 48 hours postoperatively and the need for transfusion were similar in the three groups. Therefore, Intra-articular and oral tranexamic acid, are recommended as suitable substitutes for intravenous tranexamic acid.

Keywords: Tranexamic acid, Arthroplasty, Bleeding

Medical Science, 2020, 24(106), 4632-4638

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