Elsevier

The Journal of Arthroplasty

Volume 28, Issue 7, August 2013, Pages 1080-1083
The Journal of Arthroplasty

The Effect of Tranexamic Acid on Blood Loss and Transfusion Rate in Primary Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2012.11.016Get rights and content

Abstract

Allogeneic blood transfusions remain common in primary total knee arthroplasty. We reviewed our experience with 2269 consecutive primary total knee arthroplasties in 2069 patients over a 3.5 year period. In our cohort, 1838 received no TXA, 330 received TXA via IV infusion, and 130 had TXA applied topically. The need for blood transfusion, as well as hematocrit levels immediately after surgery in the recovery room and the day of discharge were recorded. Tranexamic acid infusion demonstrated a statistically significant decrease in blood transfusion (P = 0.001), as did topical application of TXA (P = 0.019). The transfusion rate without TXA was 6.5% (120/1839) but only 0.3% (1/330) with TXA infusion. There were no transfusions (0/130) with topical TXA. Statistical differences were also noted in both immediate post operative and day of discharge hematocrit levels in patients having TXA infusion while those values for patients with TXA irrigation failed to obtain statistical significance. No significant change in the rate of symptomatic deep venous thrombosis or pulmonary embolism was noted.

Section snippets

Materials and Methods

After IRB approval, 2269 consecutive primary knee arthroplasties in 2069 patients performed by four fellowship trained orthopaedic surgeons between January 2009 and May 2012 were retrospectively reviewed. It was determined whether TXA was utilized and if so, was it given as an intravenous infusion or topically. The patients who did not receive TXA via either route served as the control group. Each patient's chart was reviewed to determine if a blood transfusion was necessary. The immediate

Results

Average patient age in our study was 65.84 ± 10.55 years. There were no significant age differences (P = 0.65) between the genders. The male average age was 65.97 ± 10.61 years while the female average age was 65.76 ± 10.46 years. There were no significant differences in preoperative hematocrit between the groups and the demographics of all groups were similar.

Among 2269 primary TKAs in 2069 patients who underwent total knee arthroplasty at our institution over 3.5 years (January 2009–May 2012), chi square

Discussion

There is a growing body of evidence that TXA, when used either as infusion or topically, has a substantial impact on blood loss and the decreasing need for post-operative transfusion following primary total knee arthroplasty. To our knowledge, this report is the largest series from a single institution.

Since the introduction of TXA at our institution into primary total knee protocol, the transfusion rate has dropped substantially. Looking at the data presented in this study, we feel the drop in

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2012.11.016.

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