Study of the outcomes of using intravenous Tranexamic acid to reduce blood loss and blood transfusion after Total Knee Arthroplasty at Langsuan Hospital, Chumphon.
Keywords:
Total knee arthroplasty, Tranexamic acid, Blood lossAbstract
Total knee replacement (TKA) surgery often involves significant blood loss, impacting recovery and increasing the risk of blood transfusions. While tranexamic acid (TXA) is a widely used treatment, determining the optimal intravenous dose for optimal efficacy and cost-effectiveness in a community hospital context remains a key issue requiring further study. This study aimed to investigate the effectiveness of TXA therapy in reducing blood loss during total knee replacement surgery between patients receiving intravenous TXA before surgery and those not receiving TXA. This randomized controlled trial (RCT) was conducted at Langsuan Hospital from November 2024 to February 2025. Forty-five patients with osteoarthritis undergoing TKA were randomly assigned into three groups of 15 participants each: Group 1 (control group) received no TXA; Group 2 received two doses of 1,000 mg TXA; and Group 3 received four doses of TXA. Data were analyzed using the Kruskal-Wallis H Test, followed by Dunn-Bonferroni pairwise comparisons, with a significance level set at 0.05.
The results of the study demonstrated that total blood loss differed significantly among the groups (p-value = 0.003), with both intravenous tranexamic acid (TXA) groups experiencing markedly lower blood loss than the non-TXA group. Pairwise comparisons revealed that during the first 24 hours postoperatively, the 2-dose TXA group achieved the lowest total blood loss, showing a statistically significant difference compared to the other groups (p-value < 0.001). Regarding intraoperative blood loss, the 4-dose TXA group exhibited the lowest volume lost, which was significantly less than that of the non-TXA group (p-value = 0.002). Importantly, no complications related to deep vein thrombosis (DVT), pulmonary embolism (PE), or cardiovascular and cerebrovascular events (stroke/MI) were observed in any study group. In conclusion, intravenous TXA administration safely and effectively reduces blood loss during total knee arthroplasty. The 2-dose regimen yielded the most effective control over blood loss within the initial 24-hour postoperative period, establishing it as the optimal strategy to incorporate into standard clinical practice guidelines to enhance cost-effectiveness and reduce healthcare staff workload.
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