Weighted Versus Uniform Dose of Tranexamic Acid in Patients Undergoing Primary, Elective Knee Arthroplasty: A Prospective Randomized Controlled Trial

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Abstract

In a prospective, randomized, double-blinded, controlled study (25 controls), TA was infused parenterally before tourniquet release in two study groups. Group 1 (n = 20) received a 1 g dose, and group 2 (n = 20) received a 20 mg/kg dose. There was no significant difference between groups 1 and 2 with intra-operative, post-operative and total blood loss. Both groups 1 and 2 exhibited significant improvements in intra-operative, post-operative, and total blood loss compared to the control group (P < 0.05). Two blood transfusions were given to one patient in the weighted group, compared to 19 transfusions (10 patients) in the control group. This study suggests that a single 1-g dose can be used with the same efficacy as a weighted 20 mg/kg dose.

Section snippets

Study Design

This study is a prospective, randomized, double-blinded controlled clinical trial to compare the effect of a single uniform 1 g dose of TA to a single weighted 20-mg/kg dose in primary TKA. Consecutive patients that were candidates for TKA in the senior author's clinic were offered enrollment in this study. Exclusion criteria included, age less than 18, age greater than 85, prior history of an open surgical procedure on the operative knee, significant cardiac disease and/or history of a previous

Results

At present 44 patients have been enrolled (enrollment rate = 55%) with 40 successfully completing the study protocol. The average age of patients in the standard group was 67.6 (range, 52–82 years), 66.5 (range, 50–76 years) in the weighted dose group, and 62.4 years (range, 44–86) in the control group. There were 6 males and 14 females enrolled in both treatment groups with an equal split of 20 patients being randomly assigned to the weighted dose and uniform dose. There were no statistically

Discussion

The addition of TA to the regimen of blood management and conservation in TKA has significantly reduced the need for allogenic transfusions with a respectable and well documented safety profile 1., 2., 4., 5.. The current study supports this literature with significant reductions in allogenic blood transfusions in primary TKA patients when using either a weighted or standard (1000 mg) dose of TA compared to control patients following the same protocols without the administration of TA. The

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The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.01.038.

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