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Tranexamic Acid Reduces Blood Transfusion, Postoperative Blood Loss

Raul Cordoba, Blanca Tapia, Olatz Aramburu, Maria-Asuncion Mora, Rafael Bielza, Javier Escalera, Jose-Ignacio Lora-Tamayo and Luis Ercoreca

Total knee arthroplasty usually has an important blood loss which may lead patients to receive allogeneic blood transfusion up to 30-45% of cases. Allogeneic blood transfusion is not free of risks, like disease transmission, ABO incompatibility, transfusion-related lung injury, fluid overload and increased procedure costs. Blood saving strategies should be implemented in surgical patients with known blood loss procedures in order to reduce allogeneic blood transfusion risk. Prophylactic use of the anti-fibrinolytic drug tranexamic acid (TXA) is useful in preventing blood loss in orthopedic surgery. In this study, 90 unilateral total knee arthroplasty with prophylactic use us TXA were compared to 60 historical cases. Patients in both groups underwent total knee arthroplasty with the same surgical technique and the same surgeon team. TXA was administered in 2 doses of 10-15 mg/kg to those patients with no contraindications, 15 minutes before ischemia release and 3 hours later. In the TXA series, there was a reduced transfusion requirements from 0.85 PRBC/patient to 0, 35 PRBC/patient (p=0.0031), and a risk reduction of 41, 17% (RR 0.56, IC95% 0.35-0.88). Visible bleeding in 24 h significantly decreased from 540 cc (IC95% 393-687) to 168 cc (IC95% 130-207) in the TXA series (p<0.0001), and a reduced length of hospital stay from 8.92 days to 7.09 days in the TXA series (p=0.03). As a conclusion, implementing a blood saving strategy based on TXA in orthopaedic patients is effective and reduces risk of allogeneic blood transfusion.