Tranexamic Acid and Tourniquet: Which Combination Reduces Blood Loss Most Effectively?

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Hematology

Background:

• Blood loss during total knee arthroplasty (TKA) increases morbidity and transfusion rates.
• Tranexamic acid and tourniquets are used to mitigate bleeding in arthroplasty.
• Optimizing their combined use is crucial for patient outcomes.

Purpose of the Study:

• To identify the optimal method for minimizing blood loss and transfusion requirements in TKA.
• To compare the efficacy of different tranexamic acid and tourniquet application strategies.

Main Methods:

• A study involving 558 patients undergoing TKA for grade 4 gonarthrosis.
• Patients were divided into four groups based on tranexamic acid and tourniquet use.
• Hemoglobin decrease and transfusion rates were analyzed, alongside demographic and clinical data.

Main Results:

• The group using both tranexamic acid and a tourniquet throughout surgery (Group 3) exhibited the lowest hemoglobin decrease and transfusion rate.
• Conversely, the group using neither agent (Group 1) showed the highest hemoglobin decrease and transfusion rate.
• Using tranexamic acid throughout surgery (Group 4) was more effective than using it only during cementation when a tourniquet was also used throughout surgery (Group 2).

Conclusions:

• The combined use of tranexamic acid and a tourniquet throughout TKA surgery is highly effective in reducing blood loss.
• This strategy significantly lowers the need for blood transfusions in patients undergoing TKA.
• This finding supports the routine adoption of this combined approach in TKA procedures.