Evaluation Of Tranexamic Acid Use in Total Knee Arthroplasty With and Without Pneumatic Tourniquet: A Prospective Randomized Study
J.C. Petry Filho, F. Kupczik, M.E.G. Schiavon, B. Sbrissia, M.D. BrunetObjective:
To evaluate the effect of intravenous ATX and pneumatic tourniquet, alone and in combination, on hemoglobin (Hb), hematocrit (Ht), and drained volume within 24 hours after TKA.
Methods:
Prospective, randomized clinical study (2×2 factorial design) with 194 patients with primary osteoarthritis, allocated to ATX or control and to tourniquet or no tourniquet. ATX was administered in two intravenous doses of 1 g (induction and end of procedure). Hb and Ht were measured preoperatively and at 24 h and analyzed by mixed ANOVA; the volume drained in 24 h was analyzed by two-factor ANOVA (α=0.05).
Results:
For Hb and Ht, there was no interaction between tourniquet and ATX over time; only the effect of time was observed (p<0.001), with Hb from 12.7 to 11.4 g/dL and Ht from 37.7% to 32.5%. For the volume drained in 24 hours, there was no tourniquet×treatment interaction (p=0.768) or main effect of the tourniquet (p=0.743). There was a main effect of ATX (p<0.001), with a lower volume drained versus control (508.7 vs. 729.3 mL), a relative reduction of 30.3%.
Conclusion:
Intravenous ATX (1 g + 1 g) significantly reduced the volume drained in 24 hours after ATJ, regardless of the use of a pneumatic tourniquet and without evidence of interaction between the interventions. Hb and Ht decreased.