最新进展

Numerous studies have suggested that the use of tranexamic acid (TA) during or prior to total knee arthroplasty (TKA) significantly reduces perioperative blood loss and allogenic transfusion requirements. One notable weakness in most of these studies is the collection of autologous blood prior to surgery which could be described as a confounding factor in determining blood loss based on hemoglobin drop, especially if protocol for blood collection is not standardized. The aim of the study was to determine the efficacy of TA in reducing blood loss and transfusion.
METHODS

We retrospectively identified 80 consecutive patients who underwent bilateral total knee arthroplasty by a single surgeon. None of these patients donated autologous blood prior to surgery. The first 40 patients did not receive TA while the second group of 40 patients received a single dose (20mg/kg) of TA approximately 10 minutes prior to deflation of tourniquet of the first knee. Patients’ charts were reviewed to identify detailed data including the hemoglobin level, hematocrit, transfusions, postoperative narcotic use and length of hospital stay.
RESULTS

Both groups of patients were largely similar based on demographic data. Blood loss, as determined by the hemoglobin drop on postoperative day 2, among patients who received TA was less than that of patients who did not receive TA (4.55 vs 5.37 g/dl.) In addition, 52% of control patients versus 8% of study patients required allogenic blood transfusion. Finally, study patients had significantly higher postoperative hemaglobins, shorter LOS, less analgesic requirements and better discharge ROM.
DISCUSSION AND CONCLUSION

It appears that use of TA with TKA does reduce postoperative bleeding and improve certain outcome parameters without a demonstrated increased risk of thromboembolic disease.