COMPARISON OF HEMOSTASIS WITH TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY

ABSTRACT Objective: To compare the use of intravenous and topical tranexamic acid (TXA) in unilateral primary total knee arthroplasty (TKA) in relation to blood loss and complications inherent to the medication. Method: Three groups with 14 patients each were constituted, and all of them were operated using the same surgical technique. In Group 1, usual measures for bleeding control were performed. Group 2 patients received TXA topically on the joint surface. In Group 3, intravenous TXA was used. Hemoglobin (HB), hematocrit (HTC), platelets (PLAT), prothrombin time, activated partial thromboplastin time and volume of blood drained observed 24 hours after arthroplasty were compared to the values of tests found before surgery. Results: There was a decrease in the concentration of HB, HTC and PLAT in all groups in relation to the preoperative, however without significant difference. Group 3 had a lower mean volume of drained blood than the other groups, with statistical significance. No adverse effects or thromboembolic events were observed in the groups that received TXA. Conclusion: This study showed superiority in the use of intravenous TXA in decreasing the volume of bleeding, without increasing the risk of thromboembolic events. Level of Evidence I, High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals.

摘要
研究目的：对比静脉输注与局部应用氨甲环酸（tranexamic acid, TXA）在单侧初次全膝关节置换术（total knee arthroplasty, TKA）中对失血量及药物相关并发症的影响。
研究方法：本研究纳入3组各14例患者，所有患者均采用相同手术技术完成手术。第1组仅实施常规止血措施；第2组患者于关节表面局部应用氨甲环酸（TXA）；第3组患者采用静脉输注氨甲环酸（TXA）。分别于关节置换术后24小时检测血红蛋白（hemoglobin, HB）、血细胞比容（hematocrit, HTC）、血小板（platelets, PLAT）、凝血酶原时间、活化部分凝血活酶时间，并与术前检测值进行对比，同时记录术后24小时引流血量。
研究结果：所有组术后的血红蛋白、血细胞比容及血小板浓度均较术前降低，但组间差异无统计学意义。第3组的平均引流血量低于其余两组，差异具有统计学意义。接受氨甲环酸治疗的两组均未观察到不良反应或血栓栓塞事件。
研究结论：本研究证实静脉输注氨甲环酸（TXA）在减少失血量方面更具优势，且未增加血栓栓塞事件风险。
证据等级：I级，即高质量随机对照试验，存在统计学差异，或虽无统计学差异但置信区间较窄。