Abstract
Bone and soft tissue bleeding often results in substantial amounts of blood loss following
total knee arthroplasty. Multiple studies have reported that cumulative blood loss
varies between 500 and 1,500 mL in primary settings. Increased perioperative blood
loss frequently requires allogeneic blood transfusions to improve the hematocrit and
the hemoglobin levels. However, allogeneic transfusion is associated with risks of
immunosuppression, transfusion reactions, graft versus host disease, and transmission
of infections. To avoid these problems and reduce costs of transfusion, multiple intraoperative
pharmacotherapeutic strategies have been developed. The various pharmacotherapeutic
agents currently used are tranexamic acid, epsilon-aminocaproic acid, fibrin, thrombin,
lavage with epinephrine, and norepinephrine. However, the relative efficacy and the
cost-effectiveness of these techniques may vary. Thus, the purpose of this study was
to provide a brief overview of the relative efficacy of various intraoperative pharmacological
methods currently in use for decreasing blood loss following total knee arthroplasty
and describe their potential complications associated with their use.
Keywords
blood - loss - prevention - pharmacotherapy - knee - arthroplasty