The effect of Intraventricular Tranexamic Acid in Two Methods before and After Opening the Tourniquet in Total Knee Arthroplasty
Authors
-
Mohammad Ali Jafari Zare
- Department of Orthopedia, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
https://orcid.org/0000-0002-9363-1922
-
Mahzad Yousofian
- Department of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
https://orcid.org/0000-0003-1299-1975
-
Farhad Pourfarzi
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
https://orcid.org/0000-0001-6442-6340
-
Hamdollah Panahpour
- Department of Basic Sciences, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
https://orcid.org/0000-0002-3315-7624
- Maryam Taghavi - School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
DOI:
https://doi.org/10.22100/jkh.v20i1.3422Keywords:
Tranexamic acid, Tourniquet, Knee osteoarthritis, Orthopedic surgeryAbstract
Introduction: Today, with the aging population, knee osteoarthritis has become one of the most common diseases in many societies, and total knee arthroplasty is one of its primary treatments. This study evaluates the impact of administering intra-articular tranexamic acid either before or after tourniquet application in patients undergoing knee replacement surgery.
Methods: This retrospective cohort study included 45 patients who underwent knee joint replacement surgery until 2021. In Group A, intra-articular tranexamic acid was administered 5 minutes before surgery, and the tourniquet was released after the injection. Another 45 patients were randomly selected from those who underwent knee joint replacement surgery until 1400, in which intra-articular tranexamic acid was administered 5 minutes after the tourniquet release (Group B). The patients' finalized medical records were examined to assess the surgical outcomes. These outcomes included changes in hemoglobin (HGB) levels 24 and 48 hours after the operation, the amount of gas used during surgery, bleeding from the drain, and various patient factors such as underlying diseases, tourniquet duration, surgery duration, BMI, age, sex, and platelet count before and after surgery.
Results: There was a significant decrease in gas consumption, hemoglobin levels, and postoperative bleeding in the group where tranexamic acid was administered before tourniquet release (P<0.05).
Conclusion: The results of this study indicated that intra-articular injection of tranexamic acid before tourniquet release significantly reduced postoperative bleeding and resource consumption.
References
Wu Y, Krishnan S, Rangayyan RM. Computer-aided diagnosis of knee-joint disorders via vibroarthrographic signal analysis: a review. Crit Rev Biomed Eng 2010;38:201-24. doi: 10.1615/critrevbiomedeng.v38.i2.60
Liu D, Graham D, Gillies K, Gillies RM. Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res 2014;26:207. doi: 10.5792/ksrr.2014.26.4.207
Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian Journal of Internal Medicine 2011;2:205-212.
Sun C, Yang X, Zhang X, Ma Q, Yu P, Cai X, et al. Personalized tourniquet pressure may be a better choice than uniform tourniquet pressure during total knee arthroplasty: A PRISMA-compliant systematic review and meta-analysis of randomized-controlled trials. Medicine 2022;101:e28981. doi: 10.1097/MD.0000000000028981.
Huang Z, Xie X, Li L, Huang Q, Ma J, Shen B, et al. Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial. J Bone Joint Surg Am 2017;99:2053-61. doi: 10.2106/JBJS.16.01525.
Kazemi SM, Mosaffa F, Eajazi A, Kaffashi M, Daftari Besheli L, Bigdeli MR, Zanganeh RF. The effect of tranexamic acid on reducing blood loss in cementless total hip arthroplasty under epidural anesthesia. Orthopedics 2010;33:17. doi: 10.3928/01477447-20091124-30.
Mohammad Fakour, SH Mousavi , S Hatami. The effect of Tranexamic Acid on Blood Loss and Hospital-Stay after Knee Replacement Surgery. Iranian Journal of Orthopaedic Surgery 2020;18:120-127. doi: 10.22034/ijos.2021.128719.
Sarzaeem MM, Kazemian G, Rasi M, Emami M, Ghaffari A, Khani S. Efficacy of Three Methods of Tranexamic Acid Administration in Reduction of Blood Loss Following Knee Arthroplasty. Iranian Journal of Orthopaedic Surgery 2013;11:1-6. doi:10.22034/ijos.2020.121082.
Marra F, Rosso F, Bruzzone M, Bonasia DE, Dettoni F, Rossi R. Use of tranexamic acid in total knee arthroplasty. Joints 2016;4:202-13.
Abdel-Aziz MA, Ahmed H, El-Nekeety AA, Abdel-Wahhab MA. Osteoarthritis complications and the recent therapeutic approaches. Inflammopharmacology 2021;29:1653-67. doi: 10.1007/s10787-021-00888-7.
Godoy C, Serra-Prat M. Effectiveness of tranexamic acid in routine performance of total knee replacement surgery. Revista Espanola de Anestesiologia y Reanimacion 2008;55:75-80. doi: 10.1016/s0034-9356(08)70513-9.
Jafari-zarea M, Yousefian M, Amani F, Panahpour H, Fada M. Comparing the effect of intravenous tranexamic acid by continuous infusion method with a separate intravenous method on bleeding after the simultaneous bilateral knee Arthroplasty. Journal of Patient Safety & Quality Improvement 2024;12:197-202. doi: 10.22038/psj.2025.83919.1447
Patel NK, Johns W, Vedi V, Langstaff RJ, Golladay GJ. Tourniquet and tranexamic acid use in total knee arthroplasty. Arthroplast Today 2020;6:246-250. doi: 10.1016/j.artd.2020.02.007
Kishimoto M, Yamana H, Inoue S, Noda T, Akahane M, Inagaki Y, et al. Suspected periprosthetic joint infection after total knee arthroplasty under propofol versus sevoflurane anesthesia: a retrospective cohort study. Can J Anaesth 2018;65:893-900. doi: 10.1007/s12630-018-1139-6.
Wong J, Abrishami A, El Beheiry H, Mahomed NN, Davey JR, Gandhi R, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. JBJS 2010;92:2503-13. doi: 10.2106/JBJS.I.01518.
Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JVV, Niemela HM, Mantyla SK, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesthesia & Analgesia 1997;84:839-44. doi: 10.1097/00000539-199704000-00026.
Charoencholvanich K, Siriwattanasakul P. Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clinical Orthopaedics and Related Research 2011;469:2874-80. doi: 10.1007/s11999-011-1874-2
Risberg B. The response of the fibrinolytic system in trauma. Acta Chirurgica Scandinavica Supplementum 1985;522:245-71.
Fahmy NR, Patel DG. Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet. JBJS 1981;63:461-5.
Maalouly J, El Assaad D, Ayoubi R, Tawk A, Darwish M, Aouad D, et al. Efficacy and safety of systemic tranexamic acid administration in total knee arthroplasty: A case series. International Journal of Surgery Case Reports 2020;73:90-4. doi: 10.1016/j.ijscr.2020.06.077
Meshram P, Palanisamy JV, Seo JY, Lee JG, Kim TK. Combined intravenous and intraarticular tranexamic acid does not offer additional benefit compared with intraarticular use alone in bilateral TKA: A randomized controlled trial. Clinical Orthopaedics and Related Research 2020;478:45-54. doi: 10.1097/CORR.0000000000000942.
Tsukada S, Kurosaka K, Nishino M, Maeda T, Hirasawa N, Matsue Y. Intraoperative intravenous and intra-articular plus postoperative intravenous tranexamic acid in total knee arthroplasty: a placebo-controlled randomized controlled trial. JBJS 2020;102:687-92. doi: 10.2106/JBJS.19.01083
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