Effects of tranexamic acid on hidden blood loss after total knee arthroplasty in animal models / 中国组织工程研究

ABSTRACT

BACKGROUND:Hidden blood loss leads to severe anemia after orthopedic joint arthroplasty.Blood transfusion is needed.Use of tranexamic acid can significantly decrease perioperative blood loss,reduce blood transfusion rate,however,mechanism of action of tranexamic acid on hidden blood loss and its relevance are not clear.OBJECTIVE:By establishing the rabbit models of total knee prosthesis,this study was designed to observe thevariation of early preoperative blood loss with tranexamic acid,and to study the effects of tranexamic acid on hidden blood loss and its influence on deep venous thrombosis of lower limb.METHODS: We designed the rabbit knee prosthesis ourselves.A total of 20 adult New Zealand rabbits were randomly divided into two groups,each group with 10 rabbits.Knee arthroplasty on the same side was performed.Experimental group received intravenous injection of 0.5 g 100 mL tranexamic acid at 15 minutes before replacement.Control group was given 100 mL sodium chloride at the same time.Blood was colected from al animals through ear vein at 1 day before replacement,3,6,24,48,72 hours and 7 days after replacement.Blood routine examination and blood coagulation function test were conducted.The content of plasma D-Dimer was determined.Simultaneously,the operation time and intraoperative bleeding amount were recorded.After replacement,lower limb venous ultrasonography was performed.RESULTS AND CONCLUSION: No significant difference in body weight,hemoglobin,hematocrit,and D-Dimer levels was detected between the two groups before replacement (P＞0.05).Significant differences in operation time and intraoperative dominant blood loss were detectable between the two groups (P＜0.05).Significant differences in hemoglobin and hematocrit were detected at 24 hours after replacement (P＜ 0.05),and these were better in the experimental group than in the control group.No significant difference in D-Dimer was observed between the two groups after replacement (P＞ 0.05).Operation time and intraoperative dominant blood loss were significantly associated with hemoglobin and hematocrit at 24 hours after replacement (P＜0.05).The changes in hemoglobin and hematocrit at 72 hours and 7 days after replacement were not apparently correlated with intraoperative D-Dimer changes.Obvious thrombus was not seen by lower limb venous ultrasonography after replacement.These results indicated that the use of tranexamic acid before total knee arthroplasty apparently reduced the intraoperative dominant blood loss,shortened operation time,and noticeably decreased hidden blood loss at 1 day after replacement,which was caused by the increased fibrinolysis with surgical stress,and did not apparently impact other hidden blood loss induced by other mechanism.Simultaneously,tranexamic acid is safe and reliable,and does not increase the risk of perioperative thrombus.