Comparison of two methods of bolus and infusion of Tranexamic acid to reduce blood loss in Total Knee Arthroplasty

Background: Until today, many studies conduct to determine the optimal dose and regimen of tranexamic acid to reduce the preoperative and postoperative blood loss in primary total knee arthroplasty. In this study, we were compared two different methods of administration (bolus and infusion). Materials and Methods: Forty patients were randomized in two groups; all the patients received 500 mg tranexamic acid before tourniquet was turned on. Group (A) consisted of 20 patients (mean age: 64± 6.1 years) received 500 mg tranexamic acid ten minutes before tourniquet was loosened and group (B) (63.5 ± 7.7 years) received 500 mg tranexamic acid IV infusion during 6 hours from the time of tourniquet loosening (total dose of TA 1 g in both groups). Intraoperative blood loss, postoperative drainage (in 6 and 12 hours), blood transfusion (in 48 hours), hematocrit and hemoglobin decrease (6 and 12 hours later) were compared between two groups. Results: The patients in group (B) had less blood loss intra- and postoperative in 6 and 12 hours, and also had less hemoglobin decrease and packed cell transfusion rate was significantly lower in these patients; compared to group (A). Conclusion: Our study demonstrated that infusion administration of tranexamic acid in primary total knee arthroplasty was more effective to reduce perioperative blood loss and the demand for blood transfusion in 48 hours.