Is there a maximal effect of tranexamic acid in patients undergoing total knee arthroplasty? A randomized controlled trial. Issue 2 (27th August 2020)

• Record Type: Journal Article
• Authors: Lei, Yiting; Xie, Jinwei; Huang, Qiang; Pei, Fuxing
• Is Part Of: MedComm. Volume 1:Issue 2(2020)
• Page Start: 219
• Page End: 227
• Publication Date: 2020-08-27
• Subjects: blood loss -- fibrinolysis -- inflammation -- total knee arthroplasty -- tranexamic acid; 610
• DOI: 10.1002/mco2.23
• Languages: English
• ISSNs: 2688-2663

Abstract

Abstract: The optimal dosing regimen of tranexamic acid (TXA) has not been determined in total knee arthroplasty (TKA). In this study, patients were randomized to receive a high initial‐dose (60 mg/kg) TXA before incision, followed by five doses 3, 6, 12, 18, and 24 hours later (A), or three doses 3, 12, and 24 hours later (B), or a single dose 3 hours later (C). The primary outcome was perioperative blood loss. Other outcomes such as, hemoglobin level, transfusion, the levels of fibrin (ogen) degradation products (FDP), D‐dimer, C‐reactive protein (CRP) and interleukin‐6 (IL‐6), coagulation parameters, and adverse events were also compared. The results showed that individuals in Groups A and B had reduced total and hidden blood loss (HBL), lower FDP, D‐dimer, CRP, and IL‐6 levels than in Group C. Such differences were also detected in HBL between Groups A and B. No differences were observed in other outcomes between Groups A and B. No differences were observed in coagulation parameters and adverse events among the three groups. In conclusion, a high initial‐dose (60 mg/kg) TXA before TKA followed by three doses can be sufficient to achieve maximal effects on total blood loss, fibrinolysis, and inflammation. Abstract : We designed this randomized controlled trial to explore the optimal dosing regimen of tranexamic acid (TXA) in total knee arthroplasty (TKA), and suggested a high initial dose TXA followed by three doses of 1 g TXA 3, 12, and 24 hours later is sufficient to achieve maximal effects on blood loss, fibrinolysis, and inflammation in TKA.