54156
document
Most effective regimen of tranexamic acid in knee arthroplasty : a prospective randomized controlled study in 240 patients . BACKGROUND The antifibrinolytic tranexamic acid reduces surgical blood loss , but studies have not identified an optimal regimen . QUESTIONS/PURPOSES We studied different dosages , timings , and modes of administration to identify the most effective regimen of tranexamic acid in achieving maximum reduction of blood loss in TKA . METHODS We prospectively studied five regimens ( four intravenous , one local ; 40 patients each ) with a control group ( no tranexamic acid ) . The four intravenous ( 10-mg/kg dose ) regimens included ( 1 ) intraoperative dose ( IO ) given before tourniquet deflation , ( 2 ) additional preoperative dose ( POIO ) , ( 3 ) additional postoperative dose ( IOPO ) , and ( 4 ) all three doses ( POIOPO ) . The fifth regimen was a single local application ( LA ) . Two independent parameters of drain loss and total blood loss , calculated by the hemoglobin balance method , were evaluated statistically . RESULTS Both parameters were reduced in all five regimens as against the control . A significant reduction in drain loss was seen in the POIO , IOPO , and POIOPO groups whereas total blood loss was significantly reduced in the POIO , POIOPO , and LA groups . The POIOPO group had the least drain loss ( 303 mL ) and least total blood loss ( 688 mL ) . The IO group had the greatest drain loss and the IOPO group the greatest total blood loss . CONCLUSIONS Single-dose tranexamic acid did not give effective results . The two-dose regimen of POIO was the least amount necessary for effective results . When compared against the control , this regimen produced reduction of drain loss and total blood loss , whereas the IOPO regimen did not . The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss .
54157
Intervention_Pharmacological
tranexamic acid
54158
Intervention_Pharmacological
antifibrinolytic tranexamic acid
54159
Intervention_Pharmacological
tranexamic acid
54160
Intervention_Physical
intravenous
54161
Intervention_Physical
local
54162
Intervention_Physical
intravenous
54163
Intervention_Surgical
intraoperative dose ( IO )
54164
Intervention_Pharmacological
additional preoperative dose ( POIO )
54165
Intervention_Pharmacological
additional postoperative dose ( IOPO )
54166
Intervention_Pharmacological
local application
54167
Intervention_Pharmacological
tranexamic acid
54168
Outcome_Physical
drain loss
54169
Outcome_Physical
total blood loss
54170
Outcome_Physical
drain loss
54171
Outcome_Physical
blood loss
54172
Outcome_Physical
drain loss
54173
Outcome_Physical
blood loss
54174
Outcome_Physical
drain loss
54175
Outcome_Physical
total blood loss
54176
Outcome_Physical
drain loss
54177
Outcome_Physical
total blood loss
54178
Outcome_Physical
drain loss
54179
Outcome_Physical
total blood loss
54180
Participant_Condition
knee arthroplasty
54181
Participant_Sample-size
240 patients
54182
Participant_Sample-size
40 patients