Optimizing effectivity of tranexamic acid in bilateral knee arthroplasty - A prospective randomized controlled study

Area of Science:

• Orthopedic Surgery
• Pharmacology
• Anesthesiology

Background:

• Tranexamic acid (TEA) is crucial for managing surgical blood loss.
• Optimal TEA regimens for bilateral total knee arthroplasty (TKA) remain undefined.
• This study addresses the need for an effective TEA protocol in bilateral TKA.

Purpose of the Study:

• To compare three distinct tranexamic acid (TEA) regimens for bilateral total knee arthroplasty (TKA).
• To determine the most effective TEA regimen for minimizing blood loss during bilateral TKA.
• To evaluate drain loss and total blood loss across different TEA administration protocols.

Main Methods:

• Prospective study involving 75 patients undergoing bilateral TKA, divided into three groups (25 each).
• Regimens evaluated: intraoperative, intravenous (IOIO); local intraoperative (LALA); and preoperative plus intraoperative, intravenous (POIOIO).
• Blood loss assessed via drain output and hemoglobin balance method.

Main Results:

• The POIOIO regimen showed significantly lower mean drain loss (412.9ml) compared to IOIO (607.2ml) and LALA (579.4ml) (p=0.0022).
• Mean total blood loss was lowest in the POIOIO group (1207ml), but differences among groups were not statistically significant (p=0.80).
• No thromboembolic events were reported across all groups.

Conclusions:

• The POIOIO tranexamic acid (TEA) regimen is most effective in reducing drain blood loss for bilateral total knee arthroplasty (TKA).
• This finding aligns with previous research on unilateral TKA, supporting the POIOIO regimen's efficacy.
• The POIOIO regimen offers a promising strategy for blood management in bilateral TKA.