1. The antifibrinolytic and anti-inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial
- Author
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Weikun Meng, Z.-P. Yu, Fuxing Pei, Q.-P. Yu, Zongke Zhou, C. Chen, Duan Wang, Wei-Nan Zeng, Lunxu Liu, and Ze-Yu Luo
- Subjects
Male ,Antifibrinolytic ,Time Factors ,Knee Joint ,medicine.drug_class ,Anti-Inflammatory Agents ,Blood Loss, Surgical ,Administration, Oral ,Inflammation ,Postoperative Hemorrhage ,Placebo ,Drug Administration Schedule ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,030202 anesthesiology ,law ,medicine ,Humans ,Range of Motion, Articular ,Arthroplasty, Replacement, Knee ,Aged ,030222 orthopedics ,business.industry ,Hematology ,Recovery of Function ,Middle Aged ,medicine.disease ,Thrombosis ,Antifibrinolytic Agents ,Biomechanical Phenomena ,Regimen ,Treatment Outcome ,Tranexamic Acid ,Anesthesia ,Female ,Hemoglobin ,medicine.symptom ,business ,Tranexamic acid ,medicine.drug - Abstract
Essentials Perioperative blood loss and inflammatory response can significantly affect recovery after surgery. We studied the effects of multiple-dose oral tranexamic acid on blood loss and inflammatory response. A postoperative four-dose regimen brought about maximum reduction in postoperative blood loss. A postoperative four-dose regimen reduced inflammatory response and promoted early rehabilitation. SUMMARY: Background Tranexamic acid (TXA) can reduce blood loss and the inflammatory response at multiple doses in total knee arthroplasty patients. However, the optimal regimen has not been determined. Objectives To identify the most effective regimen for achieving maximum reductions in blood loss and the inflammatory response. Patients/Methods Two hundred and seventy-five patients were randomized to receive a placebo (group A), a single 2-g oral dose of TXA 2 h preoperatively followed by 1 g of oral TXA 3 h postoperatively (group B), a single dose followed by 1 g of oral TXA 3 h and 7 h postoperatively (group C), a single dose followed by 1 g of oral TXA 3 h, 7 h and 11 h postoperatively (group D), or a single dose followed by 1 g of oral TXA 3 h, 7 h, 11 h and 15 h postoperatively (group E). The primary outcome was total blood loss on postoperative day (POD) 3. Secondary outcomes included a decrease in the hemoglobin level, coagulation parameters, inflammatory marker levels, and thromboembolic complications. Results Groups D and E had significantly lower blood loss and smaller decreases in hemoglobin level than groups A, B, and C, with no significant difference on POD 3 between groups D and E. Significantly enhanced coagulation was identified for the four multiple-dose regimens; however, all thromboelastographic parameters remained within normal ranges. Group E had the lowest inflammatory marker levels and pain, and the greatest range of motion. No thromboembolic complications were identified. Conclusion The four-dose regimen yielded the maximum reductions in blood loss and inflammatory response, improved analgesia, and promoted early rehabilitation. Further studies are required to ensure that these findings are reproducible.
- Published
- 2018