Comparing methods of tranexamic acid administration and blood reinfusion in reducing blood loss during total knee arthroplasty

Background: Perioperative blood loss is associated with total knee arthroplasty (TKA). The tranexamic acid (TXA) is a plasminogen activator inhibitor widely used to prevent bleeding. The Stryker CBC II ConstaVac Blood Conservation System (CBC II, Stryker) can avoid homologous blood. The purpose of this study is to compare the efficacy of intravenous and topical regimen of TXA in primary TKA, and compare the efficacy of TXA and CBC II in primary TKA. Methods: The study included 202 patients accepted primary TKA from May 2010 to May 2015. The patients were divided into four groups: 53 patients were administered intravenously with 1000 mg TXA. 54 patients in an age and gender-matched group were topical administration with 1000mg of TXA in 100 cc of saline. 49 patients in an age and gender-matched control group undergo the treatment of blood reinfusion by CBC II. Control group included 46 patients did not take TXA and CBC II. Results: Post-operative 24 h total drainage volume were lowest, and the post-operative 24 h Hgb was highest in the group administered intravenously of TXA (p<0.05). The transfusion rate, amount of red blood cell suspension and frozen plasma were lowest in the administered intravenously of TXA group (p<0.05). Here was no thromboembolic event in four groups. Conclusions: Perioperative blood loss could be reduced by intravenous and topical regimen of TXA and CBC II after TKA. In addition, the application of TXA and CBC II is not associated with increased risk of thromboembolic complications.