Journal of Orthopedics and Joint Surgery

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VOLUME 1 , ISSUE 1 ( July-December, 2019 ) > List of Articles

RESEARCH ARTICLE

Analysis of Efficacy of Tranexamic Acid in Reduction of Blood Loss and Postoperative Blood Transfusions Following Orthopedic Trauma Surgery

Paul Kingsly, Muthu Sathish, Naina Muhammad Deen Muhammad Ismail

Keywords : Antifibrinolytics, Blood loss, Blood transfusion, Orthopedic trauma surgery, Tranexamic acid

Citation Information : Kingsly P, Sathish M, Ismail NM. Analysis of Efficacy of Tranexamic Acid in Reduction of Blood Loss and Postoperative Blood Transfusions Following Orthopedic Trauma Surgery. 2019; 1 (1):27-30.

DOI: 10.5005/jp-journals-10079-1007

License: CC BY-NC 4.0

Published Online: 00-12-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Perioperative and postsurgical hemorrhage is common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and to reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Ischemia increases fibrinolysis, related to the proteolytic action of plasmin, with a subsequent fibrinogen scission, which limits postoperative coagulation and favors bleeding. Tranexamic acid being antifibrinolytic acts to prevent this effect from taking place. This study was designed to assess the efficacy of TXA in reducing blood loss and postoperative blood transfusions following the fixation of fracture of both bones of leg with intramedullary interlocking nailing of tibia done by open method. Study design: Randomized, prospective, comparative study. Materials and methods: In this study, patients were randomly allocated into two groups of 25 each. Group I received inj. TXA and group II received inj. normal saline. Preoperative hemoglobin (Hb), postoperative Hb, total blood volume (BV), blood loss, and Hb loss were compared between two groups. Statistical analysis was done with Fisher\'s t test and Fisher\'s exact test. Results: The mean blood loss in TXA and placebo group was 249.02 ± 57.04 mL and 543 ± 83.64 mL, respectively, and found to be highly significant (p value < 0.001). A number of patients required blood transfusion were significantly low in TXA group than in placebo group (p < 0.01). Conclusion: This study indicated that TXA results in significant reduction in blood loss (nearly 60%) and amount of blood transfusion required in patients undergoing surgery. Routine administration of TXA may benefit patients undergoing surgery where significant blood loss is expected.


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  1. A cost analysis of autologous and allogeneic transfusion in hip-replacement surgery. Am J Surg 1996;171(3):324–330. DOI: 10.1016/S0002-9610(97)89635-3.
  2. Blood loss and replacement in total hip arthroplasty: a multicenter study. The preoperative autologous blood donation study group. Transfusion 1992;32(1):63–67. DOI: 10.1046/j.1537-2995.1992.32192116435.x.
  3. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br 2005;87(11):1480–1482. DOI: 10.1302/0301-620X.87B11.16474.
  4. An active stereo-isomer (trans-form) of AMCHA and its antifibrinolytic (antiplasminic) action in vitro and in vivo. Keio J Med 1964;13:177–185. DOI: 10.2302/kjm.13.177.
  5. Biochemistry and toxicology of amikapron; the antifibrinolytically active isomer of AMCHA. (A comparative study with epsilon-aminocaproic acid). Acta Pharmacol Toxicol (Copenh) 1965;22(4):340–352. DOI: 10.1111/j.1600-0773.1965.tb01829.x.
  6. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999;57(6):1005–1032. DOI: 10.2165/00003495-199957060-00017.
  7. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 1997;84(4):839–844. DOI: 10.1213/00000539-199704000-00026.
  8. A simple computer program for randomly allocating treatment. Indian J Pharmacol 2001;33:452–453.
  9. Postoperative blood retrieval and transfusion in cementless total knee arthroplasty. J Arthroplasty 1992;7(2):205–210. DOI: 10.1016/0883-5403(92)90019-M.
  10. Causes and consequences of critical bleeding and mechanisms of blood coagulation. Pharmacotherapy 2007;27(9 Pt 2):45S–56S. DOI: 10.1592/phco.27.9part2.45S.
  11. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 2003;90(5):596–599. DOI: 10.1093/bja/aeg111.
  12. Effectiveness and safety of tranexamic acid administration during total knee arthroplasty. Vox Sang 2008;95:39–44. DOI: 10.1111/j.1423-0410.2008.01045.x
  13. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion 2008;48(3):519–525. DOI: 10.1111/j.1537-2995.2007.01564.x.
  14. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2011;1:CD001886. DOI: 10.1002/14651858.CD001886.pub3.
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