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Open Access Highly Accessed Research article

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

Yasir J Sepah1, Masood Umer2*, Tashfeen Ahmad3, Faria Nasim1, Muhammad Umer Chaudhry1 and Muhammad Umar4

Author Affiliations

1 Aga Khan University Medical College, Karachi-74800, Pakistan

2 Associate Professor Department of Surgery (Orthopedics) Aga Khan University Hospital, Karachi-74800, Pakistan

3 Assistant Professor Department of Surgery (Orthopedics) Aga Khan University Hospital, Karachi-74800, Pakistan

4 Professor Department of Surgery (Orthopedics) Aga Khan University Hospital, Karachi-74800, Pakistan

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Journal of Orthopaedic Surgery and Research 2011, 6:22  doi:10.1186/1749-799X-6-22

Published: 21 May 2011

Abstract

Background & Purpose

Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery.

Methodology

This was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5%) knees (group-I) had received tranexamic acid (by surgeon preference) while the remaining fifty-two patients with 66 (51.5%) knees (group-II) had did not received any tranexamic acid either pre- or post-operatively.

Results

The mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral) and 2695 ml (bilateral). In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral) and 1.94 gm/dl (bilateral), with a mean drainage of 826 ml (unilateral) and 1288 ml (bilateral) (p-value < 0.001).

Interpretation

Tranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.