Abstract

ROLE OF TRANEXAMIC ACID IN REDUCING INTRA AND POST OPERATIVE BLOOD LOSS IN PATIENTS UNDERGOING TOTAL KNEE REPLACEMENTS

*Bhavkaran Singh, R. K. Arora, Gagan Khanna and Kamalpreet Singh

Abstract

Background & Objectives: Total blood loss (TBL) which may vary between 1450-1750 ml in total knee replacement (TKR) is associated with extra risk to the patients not only due to postoperative anaemia but also due to complications associated with subsequent blood transfusion. Tranexamic acid (TA) as anti fibrinolytic agent reduces bleeding at the surgical site but literature available shows no consensus on the effective dose, route and time of administration of TA. Present prospective randomized interventional study was taken up to study the effect and safety of TA on total and hidden blood loss (HBL) in patients undergoing TKR. Methods: 60 patients were randomly divided into (TA+) and (TA-) group of thirty patients each. In (TA+) 10 mg/kg of TA was given intravenously 30 minutes prior to inflation of the tourniquet and repeated 3 hours later postoperatively. TBL was estimated from volume of blood recovered in drains (TBL1) and from hemoglobin loss (TBL2). The data collected was tabulated and statistically analysed. Results: TA significantly decreased intraoperative (p=0.0149), postoperative TBL (p<0.000) including HBL in TA+ Group (p= <0.000) when compared with controls. 63% patients in (TA-) and none in (TA +) Group required blood transfusion. Conclusion: Two doses of 10mg/kg TA intravenously at three hours interval decreased intraoperative blood loss by 13%, TBL in drains by 39%, HBL by 55% and subsequent reduction in blood transfusion rate by 63%.

Keywords: Hidden blood loss, Intravenous, Knee replacement, Total blood loss, Tranexamic acid.