The effects of multiple intravenous tranexamic acid administrations after total knee arthroplasty on fibrinolytic activity and inflammatory response / 中华骨科杂志

ABSTRACT

Objective To explore the effects of multiple intravenous tranexamic acid (Ⅳ-TXA) administrations after total knee arthroplasty (TKA) on fibrinolytic activity and inflammatory response in an enhanced recovery after surgery (ERAS) program and to assess the efficacy and safety of Ⅳ-TXA.Methods One hundred and forty-one severe knee osteoarthritis patients following primary unilateral TKA from January 2016 to April 2017 were investigated retrospectively.The patients were divided into following three groups based on the dosage of Ⅳ-TXA after surgery40 patients received ≤3 g Ⅳ-TXA after surgery (group T1),50 patients received 4 g (group T2) and the other 51 patients received ≥5 g Ⅳ-TXA (group T3).The total blood loss (TBL),hidden blood loss (HBL),transfusion rate,maximum hemoglobin (Hb) drop,the incidence of intramuscular venous thrombosis,deep vein thrombosis (DVT) and pulmonary embolism (PE),fibrinolysis parameters [fibrin(-ogeu) degradation products (FDP),D-dimer],and inflammation markers [C-reactive protein (CRP),interleukin-6 (IL-6)] during perioperative period were evaluated.In addition,correlation analyses between the dosage of Ⅳ-TXA and fibrinolysis parameters and inflammation markers were conducted.Results The mean TBL,HBL and maximum Hb drop in group T2 (537.16±270.43 ml,431.36±271.99 ml,19.68± 10.68 g/L) and T3 (541.31±290.00 ml,439.94±290.71 ml,20.24±8.48 g/L) were lower than those in group T1 (748.22±394.34 ml,P=0.012,0.013;636.47±388.14 ml,P=0.011,0.015;25.88± 11.77 g/L,P=0.005,0.010,respectively).No patient needed transfusion in all groups.There was no statistically difference in the incidence of intramuscular venous thrombosis of lower limbs among three groups (P＞ 0.05).No episode of DVT or PE occurred in any group in two weeks after surgery.There were negative correlation between the dosage of Ⅳ-TXA and FDP at postoperative day 1 and day 3 (r=-0.191,P=0.025;r=-0.291,P=0.001) and D-dimer on postoperative day 3 (r=-0.176,P=0.048).Moreover,the CRP (r=-0.184,P=0.036) and IL-6 (r=-0.269,P=0.002) level in serum on postoperatire day 1 also showed a negative relationship with the dosage of Ⅳ-TXA after surgery.Conclusion The multiple Ⅳ-TXA (≥4 g) after surgery can further reduce the TBL,HBL and maximum Hb drop following primary TKA in ERAS program without increasing the risk of thrombotic events.Most importantly,the effect of anti-fibrinolysis will be enhanced and may have an anti-inflammatory effect with the dosage of Ⅳ-TXA increased.