Evaluating Effect of Tranexamic Acid on Blood Loss in Patients undergoing Simultaneous Bilateral Knee Replacement Surgery: A Quasi-experimental study.

Background and Objective: Physicians have always been looking for strategies to reduce the volume of blood loss and the need for blood transfusion after surgeries. Due to the increasing prevalence of orthopedic surgeries and especially joint replacement, this study aimed to evaluate the efficacy of using tranexamic acid as an anti-fibrinolytic in reducing bleeding in patients undergoing total knee replacement surgery.Methods and Materials: In this quasi-experimental study, ۲۶ patients referred to the orthopedic clinic of Aria Hospital in Mashhad in ۲۰۱۸-۲۰۲۰, who were diagnosed with osteoarthritis and needed total knee replacement surgery, after obtaining consent entered the study. Patients were divided into two groups of control and case. Patients with any history of blood coagulation disorders, drug allergies, pregnancy, fracture-induced arthroplasties, taking nonsteroidal anti-inflammatory drugs or drugs related to blood clotting in the past ۷ days, kidney or liver failure And a history of venous thrombosis or pulmonary embolism were excluded. Blood sample were taken from all subjects before the surgery. The case group was injected with ۱ gram of intravenous tranexamic acid as a single dose about ۵ minutes before surgical incision, but no tranexamic acid was injected for the control group. After ۲۴ hours of surgery, blood tests were taken from the patients again and the hemoglobin, hematocrit and red blood cells were recorded. The results obtained before and after the operationwere compared in the two groups. Student test, Mann-Whitney and Chi-square tests were used to analyze the data. The software used in this study was SPSS v.۲۶ and the significant level was considered less than ۰.۰۵. Findings: In this study, data of ۶ men and ۲۰ women who underwent total knee replacement surgery were analyzed. The mean age and body weight of patients were ۶۷.۸۵±۸.۱۷ years and ۷۰.۷۷±۷.۹۸ kg, respectively.Volume of blood loss was significantly lower in the case group compared to the control group (P = ۰.۰۲۶). Also, subjects of the case group needed less blood transfusion after the surgery (P = ۰.۰۳۶). No significant correlations were found between age, sex, weight, hematocrit, hemoglobin level and red bloodcell count with tranexamic acid intake (P> ۰.۰۵).Conclusion: Injection of tranexamic acid had a promising effect on the reduction of blood loss and blood transfusion in patients undergoing total knee joint replacement surgery. Tranexamic acid can be used to prevent bleeding-related complications after the surgeries to save further costs of treatment.

Keywords:

Tranexamic acid , total knee joint replacement , Blood transfusion , Blood loss