Cocktail therapy reduces hidden blood loss after total knee arthroplasty / 中国组织工程研究

ABSTRACT

BACKGROUND:Blood loss after total knee arthroplasty is a common problem that wil affect the clinical effects. As a kind of hemostatic medicine, tranexamic acid has been more and more used in reducing bleeding after joint replacement. However, there are few studies concerning the combined use of tranexamic acid with other hemostatic drugs. OBJECTIVE:To evaluate the efficacy and safety of intra-articular administration of cocktail wine (tranexamic acid plus diluted-epinephrine) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty. METHODS:From July 2013 to October 2015, 113 patients scheduled to undergo total knee arthroplasty were randomized into two groups. Cocktail wine group (57 patients) received intra-articular cocktail wine (3 g tranexamic acid plus 0.25 mg diluted-epinephrine;1200 000). Tranexamic acid group (56 patients) received 3 g topical tranexamic acid alone. Al patients were not drain inserted after the operation. During perioperative period, intraoperative blood loss, postoperative dominant blood loss, occult blood loss and al ogeneic blood transfusion were observed. Within postoperative 90 days, the incidences of symptomatic deep venous thrombosis and pulmonary embolism were observed. RESULTS AND CONCLUSION:(1) The topical administration of cocktail wine significantly reduced total blood loss (P=0.007), hidden blood loss (P=0.000) and transfusion rate (0%vs. 5.4%), without increasing the risk of thromboembolic and hemodynamic complications (P>0.05). (2) Therefore, the hemostatic effect of topical tranexamic acid plus diluted-epinephrine was better than tranexamic acid alone. Their combination does not produce severe adverse reactions, and can be used as an important method to reduce blood loss after total knee arthroplasty.