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Optimal dose of topical tranexamic acid considering efficacy and safety in total knee arthroplasty: a randomized controlled study
- Source :
- Knee Surgery, Sports Traumatology, Arthroscopy. 29:3409-3417
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- This study aimed to evaluate the optimal dosage of topical tranexamic acid (TXA) considering the efficacy and safety for controlling bleeding after total knee arthroplasty (TKA). This prospective randomized double-blinded placebo-controlled comparative study included 325 patients scheduled to undergo TKA, who were randomly assigned to five groups based on the topical TXA injection (n = 65 per group): control; group 1, 0.5 g TXA; group 2, 1.0 g TXA; group 3, 2.0 g TXA; and group 4, 3.0 g TXA. The primary outcome was decrease in postoperative hemoglobin levels. The secondary outcomes were blood loss calculated using Good’s method, drainage volume, frequency of transfusion, and range of motion (ROM). Plasma TXA levels and complications were also evaluated. Significant differences were noted in the decrease in hemoglobin levels between the control group and groups 2 (p = 0.0027), 3 (p = 0.005), and 4 (p = 0.001). No significant differences were shown among the experimental groups. Significant differences in total blood loss and frequency of transfusion were noted between the control group and groups 2 (p = 0.004, 0.002, respectively), 3 (p = 0.007, 0.001, respectively), and 4 (p = 0.001, 0.009, respectively) without showing significant differences among the experimental groups. With respect to drainage volume, no significant differences were observed among the groups. The serum TXA levels increased proportionally with the applied dose of topical TXA immediately and at 3 and 6 h postoperatively. Symptomatic deep vein thrombosis or pulmonary embolism was not observed in any group. Other complications related to TXA administration were not detected. Topical application of 1.0 g or more of TXA shows significant bleeding control without a dose–response relationship. Blood TXA levels increase with the TXA dose following topical TXA application. Therefore, to prevent overdosing and reduce potential complications with ensuring the effectiveness, 1.0 g of TXA is recommended as a topical application. I.
- Subjects :
- medicine.medical_specialty
Sports medicine
Administration, Topical
Deep vein
Blood Loss, Surgical
Postoperative Hemorrhage
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
medicine
Humans
Orthopedics and Sports Medicine
Prospective Studies
Arthroplasty, Replacement, Knee
030222 orthopedics
business.industry
030229 sport sciences
medicine.disease
Thrombosis
Antifibrinolytic Agents
Pulmonary embolism
medicine.anatomical_structure
Tranexamic Acid
Anesthesia
Orthopedic surgery
Administration, Intravenous
Surgery
business
Range of motion
Tranexamic acid
medicine.drug
Subjects
Details
- ISSN :
- 14337347 and 09422056
- Volume :
- 29
- Database :
- OpenAIRE
- Journal :
- Knee Surgery, Sports Traumatology, Arthroscopy
- Accession number :
- edsair.doi.dedup.....e6007fd8159f5bb3c556f0b77e49cd20