COMPARISON OF HEMOSTASIS WITH TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY

To compare the use of intravenous and topical tranexamic acid (TXA) in unilateral primary total knee arthroplasty (TKA) in relation to blood loss and complications inherent to the medication.

Method:

Three groups with 14 patients each were constituted, and all of them were operated using the same surgical technique. In Group 1, usual measures for bleeding control were performed. Group 2 patients received TXA topically on the joint surface. In Group 3, intravenous TXA was used. Hemoglobin (HB), hematocrit (HTC), platelets (PLAT), prothrombin time, activated partial thromboplastin time and volume of blood drained observed 24 hours after arthroplasty were compared to the values of tests found before surgery.

Results:

There was a decrease in the concentration of HB, HTC and PLAT in all groups in relation to the preoperative, however without significant difference. Group 3 had a lower mean volume of drained blood than the other groups, with statistical significance. No adverse effects or thromboembolic events were observed in the groups that received TXA.

Conclusion:

This study showed superiority in the use of intravenous TXA in decreasing the volume of bleeding, without increasing the risk of thromboembolic events. Level of Evidence I, High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals.

Keywords:
Tranexamic Acid; Arthroplasty; Knee; Hemorrhage; Antifibrinolytic Agents; Osteoarthritis; Knee

HB		Mean	Median	Standard Deviation	DC	Min	Max	N	CI	P-value
Group 1	Pre	13.18	12.8	1.24	9%	11.4	15.4	14	0.65	<0.001*
Group 1	Post	10.36	10.4	1.25	12%	8.1	12.9	14	0.65	<0.001*
Group 2	Pre	13.48	13.5	0.94	7%	11.9	15.4	14	0.49	<0.001*
Group 2	Post	10.99	11.0	1.06	10%	9.0	12.5	14	0.56	<0.001*
Group 3	Pre	13.03	13.2	1.19	9%	10.8	14.4	14	0.63	<0.001*
Group 3	Post	10.35	10.6	1.62	16%	7.7	13.0	14	0.85	<0.001*

HTC		Mean	Median	Standard Deviation	DC	Min	Max	N	CI	P-value
Group 1	Pre	39.54	39.4	3.68	9%	34.4	45.8	14	1.93	<0.001*
Group 1	Post	30.54	30.7	3.35	11%	23.9	36.3	14	1.75	<0.001*
Group 2	Pre	40.44	40.3	2.81	7%	34.7	45.3	14	1.47	<0.001*
Group 2	Post	32.71	32.4	3.37	10%	27.3	38.4	14	1.77	<0.001*
Group 3	Pre	39.65	40.7	3.70	9%	33.0	44.7	14	1.94	<0.001*
Group 3	Post	30.81	30.8	4.84	16%	23.2	38.9	14	2.54	<0.001*

PLAT		Mean	Median	Standard Deviation	DC	Min	Max	N	CI	P-value
Group 1	Pre	230.607	233.000	51.136	22%	129.000	309.000	14	26.786	<0,001*
Group 1	Post	171.500	169.000	37.910	22%	110.000	245.000	14	19.858	<0,001*
Group 2	Pre	214.286	210.500	48.175	22%	156.000	299.000	14	25.235	0,022
Group 2	Post	183.357	178.000	31.532	17%	137.000	236.000	14	16.517	0,022
Group 3	Pre	224.407	233.000	38.426	17%	139.000	292.000	14	20.128	<0,001*
Group 3	Post	173.071	180.000	28.261	16%	126.000	219.000	14	14.804	<0,001*

Gain		Mean	Median	Standard Deviation	DC	Min	Max	N	CI	P--value
HB	Group 1	-2.82	-2.66	1.11	39%	-4.50	-1.00	14	0.58	0.756
	Group 2	-2.49	-2.25	1.16	47%	-4.70	-1.10	14	0.61
	Group 3	-2.68	-2.55	1.19	44%	-5.30	-1.00	14	0.62
HTC	Group 1	-8.99	-8.90	3.71	41%	-16.10	-2.80	14	1.94	0.570
	Group 2	-7.73	-6.50	3.28	42%	-13.40	-4.10	14	1.72
	Group 3	-8.84	-8.40	3.26	37%	-14.50	-2.70	14	1.71
PLAT	Group 1	-59.107	-60.500	29.031	49%	-122.500	-17.000	14	15.207	0.104
	Group 2	-30.929	-17.000	44.517	144%	-138.000	8.000	14	23.319
	Group 3	-51.336	-58.500	29.693	58%	-91.000	23.000	14	15.554

Groups		Mean	Median	Standard Deviation	DC	Min	Max	N	CI	P-value
PT (ATV%)	Group 1	89.3	88.0	7.3	8%	78.5	100.0	14	3.8	0.516
	Group 2	92.0	93.1	10.9	12%	77.6	115.5	14	5.7
	Group 3	92.9	95.1	7.3	8%	76.7	100.0	14	3.8
PT (INR)	Group 1	1.056	1.065	0.068	6%	0.880	1.150	14	0.036	0.377
	Group 2	1.058	1.030	0.082	8%	0.940	1.260	13	0.045
	Group 3	1.051	1.055	0.052	5%	1.000	1.190	14	0.027
APTT	Group 1	1.006	1.000	0.121	12%	0.820	1.280	14	0.063	0.288
	Group 2	1.054	1.010	0.077	7%	1.000	1.250	14	0.040
	Group 3	1.008	1.015	0.063	6%	0.850	1.072	14	0.033
Drained Blood	Group 1	453.6	475.0	191.9	42%	200.0	710.0	14	100.5	0.001*
	Group 2	341.1	332.5	216.7	64%	100.0	890.0	14	113.5
	Group 3	180.1	165.0	106.5	59%	55.0	400.0	14	55.8

		Group 1	Group 2
Drained Blood	Group 2	0,229
Drained Blood	Group 3	0,001*	0,055

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[1] Correspondence:
Otávio Montovanelli Monteiro. Rua Desembargador Augusto Botelho, 645, apto. 304, Vila Velha, ES, Brazil, 29101110. otaviomm88@gmail.com