[Efficacy of different doses and timing of tranexamic acid in major orthopedic surgeries: a randomized trial]

Tranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication.

Two hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 each: placebo, low dose (bolus 10mg.kg^-1), low dose+maintenance (bolus 10mg.kg^-1+maintenance 1mg.kg^-1.hr^-1), high dose (bolus 30mg.kg^-1) and high dose+maintenance (bolus 30mg.kg^-1+maintenance 3mg.kg^-1.hr^-1). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hours postoperative period. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period.

The intraoperative blood loss was 440±207.54mL in the placebo group, 412.5±208.21mL in the low dose group, 290±149.6ml in the low dose plus maintenance group, 332.5±162.33mL in the high dose group and 240.7±88.15mL in the high dose maintenance group (p <0.001). The reduction in postoperative blood loss in the drain for the first 24hours was 80±44.44mL in the placebo group, 89.88±44.87mL in the low dose group, 56.7±29.12mL in the low dose plus maintenance group, 77.9±35.74mL in the high dose group and 46.7±19.9mL in the high dose maintenance group (p <0.001). DVT was not encountered in any patient.

Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose+maintenance group.