The effect of postoperative intravenous drip oftranexamic acid on perioperative blood loss in patients undergoing total knee arthroplasty / 中国医师进修杂志

ABSTRACT

Objective:To explore the effect of postoperative intravenous drip of tranexamic acid on perioperative blood loss, coagulation function and knee joint function in patients undergoing total knee arthroplasty.Methods:A total of 100 patients who underwent unilateral total knee arthroplasty for the first time from August 2018 to August 2020 in Dingzhou People′s Hospital were selected and divided into the tranexamic acid group and the control group according to registration order, with 50 cases in each group. The tranexamic acid group was given intravenous infusion of tranexamic acid immediately after the operation, and the control group was given intravenous infusion with the same dose of normal saline after the operation. The postoperative drainage volume was evaluated at 12 h after the treatment, and the total blood loss and occult blood loss were calculated. The change value of hemoglobin, related indexes of the coagulation function at 24 h after the operation, the knee joint range of motion before and after the operation, and Hospital for Special Surgery knee score (HSS score) were recorded. The proportion of blood transfusion, the rate of deep vein thrombosis and the incidence of pulmonary embolism were compared.Results:The postoperative drainage, total blood loss and occult blood loss in the tranexamic acid group were significantly lower than those in the control group ( P<0.05). The change value of hemoglobin in the tranexamic acid group was significantly lower than that in the control group (33.32 ± 8.87) g/L vs. (47.37 ± 9.26) g/L, t = 7.75, P<0.05. There was no statistically significant difference in related indexes of coagulation function in the two group at 24 h after the operation ( P>0.05). The range of motion of the knee joint and the HSS scores in the tranexamic acid group were significantly greater than those in the control group (98.57 ± 7.28)° vs. (87.20 ± 8.05)°, (87.25 ± 8.30) points vs. (78.37 ± 10.20) points, t =7.41, 4.78, P<0.05. The proportion of postoperative blood transfusion, the rate of deep vein thrombosis and the incidence of pulmonary embolism in the tranexamic acid group were significantly lower than those in the control group 14.0%(7/50) vs. 32.0%(16/50), 6.0%(3/50) vs. 20.0%(10/50), 4.0%(2/50) vs. 16.0%(8/50), χ2 = 4.57, 4.33, 4.00, P<0.05. Conclusions:Tranexamic acid can reduce perioperative bleeding in patients undergoing total knee arthroplasty, reduce the proportion of patients undergoing blood transfusion, without increasing the risk of thrombosis and pulmonary embolism complications. Besides, it doesnot affect the coagulation function, and can accelerate the recovery of knee joint function.