Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study

Background: Extensive blood loss in total knee replacement (TKR) surgery is well known and is associated with a high transfusion rate of allogenic blood. Tranexamic acid (TXA) has been shown to reduce blood loss by 50% in this patient group, but only in cases with a perioperative loss of 1400-1800 ml. This study was performed to see if TXA offers any advantages in knee replacement surgery with blood loss at 800 ml. Methods: Thirty consecutive patients scheduled for TKR in spinal anesthesia with the use of a tourniquet, were randomized to TXA or non-TXA. Tranexamic acid 10 mg kg(-1) was given at conclusion of surgery and again 3 h later. Blood loss was registered. Results: Total blood loss was at all times significantly lower in the TXA group compared to the non-TXA group (409.7 +/- 174.9 ml vs. 761.7 +/- 313.1 ml; P < 0.001). There were no differences in coagulation parameters. No patients in the TXA group had a blood transfusion vs. 13% in the non-TXA group (NS). No complications were registered in the two groups. Conclusion: We conclude that TXA significantly reduces blood loss after total knee replacement surgery.