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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(02): 320-325
DOI: 10.1055/s-0042-1757958
Artigo Original
Joelho

Comparison of Blood Loss with the Use of Intravenous and Intraarticular Tranexamic Acid Versus Isolated Intraarticular in Primary Knee Arthroplasty[*]

Article in several languages: português | English
Elemar da Silva Resch 
1   Departamento de Ortopedia e Traumatologia, Hospital Universitário de Santa Maria, Santa Maria, RS, Brasil
,
Leandro Silvestro Lemos 
2   Departamento de Ortopedia e Traumatologia, Clínica Millenarium Multi Especialidades, Porto Alegre, RS, Brasil
,
José Salvador Pantoja dos Santos 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
,
João Fernando Argento Pozzi 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
,
Ewerton Renato Konkevicz 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
› Author Affiliations Financial Support There was no financial support from public, commercial, or non-profit sources.
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Abstract

Objective The objective of this work is to compare blood loss during primary knee arthroplasty with the use of intravenous and intraarticular (IV + IA) tranexamic acid versus intraarticular (IA) tranexamic acid alone.

Methods This is a randomized, double-blind clinical trial. Patients with indication for primary total knee arthroplasty were recruited in a specialized clinic, where they were operated by the same surgeon, always using the same surgical technique. Thirty patients were allocated in the IV + IA tranexamic acid group and 30 patients in the IA tranexamic acid group, according to randomization. Blood loss was compared through hemoglobin, hematocrit, drain volume, and blood loss estimation (Gross and Nadler calculus).

Results After collection, data from 40 patients were analyzed, 22 in the IA group and 18 in the IV + IA group. There were 20 losses due to collection error. Between groups IA and IV + IA, there were no significant differences in 24 hours between hemoglobin levels (10.56 vs. 10.65 g/dL; F1.39 = 0.63, p = 0.429), erythrocyte (3.63 vs. 3.73 million/mm3; F1.39 = 0.90, p = 0.346); hematocrit (32.14 vs. 32.60%; F1.39 = 1.39, p = 0.240); drainage volume (197.0 vs. 173.6 mL; F1.39 = 3.38 p = 0.069); and estimated blood loss (1,002.5 vs. 980.1; F1.39 = 0.09, p = 0.770). The same occurred in comparisons conducted after 48 hours postoperatively. Time was a significant factor for the change of all outcome variables. However, the treatment did not modify the effect of time on these outcomes. No individual presented any thromboembolic event during the work period.

Conclusions The use of IV + IA tranexamic acid showed no advantage in reducing blood loss when compared to the use of IA tranexamic acid alone in primary knee arthroplasties. This technique proved to be safe, since no thromboembolic event occurred during the development of the work.

Keywords

arthroplasty, replacement, knee - tranexamic acid - blood loss

* Work developed at Regina Hospital, Novo Hamburgo, RS, Brazil.




Publication History

Received: 29 December 2021

Accepted: 12 September 2022

Article published online:
25 May 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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