Comparing the effect of intravenous tranexamic acid by continuous infusion method with a separate intravenous method on bleeding after the simultaneous bilateral knee Arthroplasty

Document Type : Original Article

Authors

1 Department of Orthopedic, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

2 Department of Anethesiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

3 Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

4 Department of Physiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

5 School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

10.22038/psj.2025.83919.1447

Abstract

Introduction:
Significant postoperative bleeding is linked to total knee arthroplasty (TKA), and tranexamic acid (TXA), a strong medication with strong anti-fibrinolytic properties, can lessen surgical bleeding. This study compared the effects of continuous intravenous tranexamic acid infusion with a separate intravenous approach concerning postoperative bleeding in synchronic bilateral knee arthroplasty.
 
Materials and Methods:
Hemoglobin changes (24 and 48 hours after surgery), the gases used during the procedure, and the amount of bleeding were assessed in 120 patients who had simultaneous bilateral knee replacement surgery and received intravenous tranexamic acid by continuous infusion (n = 40), single intravenous injection (n = 40), or without injection (n = 40).
 
Results:
In 120 patients who underwent simultaneous bilateral knee replacement surgery and received intravenous tranexamic acid by continuous infusion (n = 40), single intravenous injection (n = 40), or no injection (n=40), hemoglobin changes (24, 48 hours postoperatively), the gases used during the procedure, and the extent of bleeding were evaluated.
 
Conclusion:
The current study's findings demonstrated that the rate of postoperative hemorrhage and the quantity of gases used in continuous infusion and stat intravenous were reduced compared to the control group. Furthermore, the continuous infusion strategy decreased postoperative hemorrhage and gas consumption compared to the stat intravenous approach.

Keywords

Main Subjects


  1. Tan J, Chen H, Liu Q, Chen C, Huang W. A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. Journal of surgical research. 2013;184(2):880-7.
  2. De-jie F, Cheng C, Lin G, Liu Y. Use of intravenous tranexamic acid in total knee arthroplasty: A meta-analysis of randomized controlled trials. Chinese Journal of Traumatology. 2013;16(2):67-76.
  3. Yang Z-G, Chen W-P, Wu L-D. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: A meta-analysis. JBJS. 2012;94(13):1153-9.
  4. Lin S-Y, Chen C-H, Fu Y-C, Huang P-J, Chang J-K, Huang H-T. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty. The Journal of arthroplasty. 2015;30(5):776-80.
  5. Xie J, Hu Q, Ma J, Huang Q, Pei F. Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhanced-recovery primary total hip arthroplasty: a randomised clinical trial. The bone & joint journal. 2017;99(11):1442-9.
  6. Morrison R, Tsang B, Fishley W, Harper I, Joseph J, Reed M. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: the effectiveness of a single pre-operative dose. Bone & joint research. 2017;6(8):499-505.
  7. Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clinical Orthopaedics and Related Research®. 2012;470(9):2605-12.
  8. Cao G, Chen G, Huang Q, Huang Z, Alexander PG, Lin H, et al. The efficacy and safety of tranexamic acid for reducing blood loss following simultaneous bilateral total knee arthroplasty: a multicenter retrospective study. BMC musculoskeletal disorders. 2019;20(1):1-6.
  9. D’Souza RS, Duncan CM, Whiting DR, Brown MJ, Warner MA, Smith HM, et al. Tranexamic acid is associated with decreased transfusion, hospital length of stay, and hospital cost in simultaneous bilateral total knee arthroplasty. Bosnian Journal of Basic Medical Sciences. 2021;21(4):471.
  10. Tsukada S, Kurosaka K, Nishino M, Maeda T, Yonekawa Y, Hirasawa N. Intra-articular tranexamic acid as an adjunct to intravenous tranexamic acid for simultaneous bilateral total knee arthroplasty: a randomized double-blind, placebo-controlled trial. BMC musculoskeletal disorders. 2019;20(1):1-7.
  11. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JVV, Niemela HM, Mantyla SK, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesthesia & Analgesia. 1997;84(4):839-44.
  12. Bouali Y, Rais K, Belhaj H, Jabri H, Kaabachi O. Continuous vs. repeated bolus of tranexamic acid for total knee arthroplasty: 6AP4-6. European Journal of Anaesthesiology| EJA. 2011;28:89-90.
  13. Wong J, Abrishami A, El Beheiry H, Mahomed NN, Davey JR, Gandhi R, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. JBJS. 2010;92(15):2503-13.
  14. Maalouly J, El Assaad D, Ayoubi R, Tawk A, Darwish M, Aouad D, et al. Efficacy and safety of systemic tranexamic acid administration in total knee arthroplasty: A case series. International Journal of Surgery Case Reports. 2020;73:90-4.
  15. Lei Y-T, Xie J-W, Huang Q, Huang W, Pei F-X. The antifibrinolytic and anti-inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial. International orthopaedics. 2020;44(3):477-86.
  16. Hourlier H, Reina N, Fennema P. Single dose intravenous tranexamic acid as effective as continuous infusion in primary total knee arthroplasty: a randomised clinical trial. Archives of orthopaedic and trauma surgery. 2015;135(4):465-71.