Ratul Kundu1, Anjan Das2, Sandip Roy Basunia2, Tapas Bhattacharyya2, Surajit Chattopadhyay3, Anindya Mukherjee4
1Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Bankura, India.
2Department of Anaesthesiology, College of Med and Sagore Dutta Hospital, Bankura, India.
3Department of Anaesthesiology, Bankura Sammilani Medical College, Bankura, India.
4Department of Anaesthesiology, N. R. S Medical College and Hospital, Kolkata, West Bengal, India.
Background: Total knee replacement (TKR) is associated with high-perioperative blood loss, which often requires allogenic blood transfusion. Among the many strategies to decrease the need for allogenic transfusion, tranexamic acid (TA) is used systemically in perioperative setting with promising outcome. Here we evaluated the efficacy of single preoperative bolus dose of TA on reduction in blood loss and red blood cell transfusion in patients undergoing unilateral TKR. Materials and Methods: 70, American Society of Anesthesiologists I-II patients scheduled for unilateral TKR were included. Patients were randomly allocated into two groups to receive either TA (Group-TA; 20 mg/kg diluted to 25 cc with normal saline) or an equivalent volume of normal saline (Group P). Hemoglobin concentration, packed cell volume, platelet count, fibrinogen level, D-dimer level was measured preoperatively and at 6 th and 24 th h postoperative period. Results: In Group P more blood, colloid and crystalloid solutions were used to replace the blood loss. 27 patients in Group TA did not require transfusion of any blood products compared to 6 patients in Group P (P < 0.0001) and only 3 units of blood was transfused in Group TA where as a total of 32 units of blood was transfused in Group P. Despite the more numerous transfusions, Hb% after 6 h and 24 h in Group P were considerably low in comparison with Group TA (P < 0.0001). Conclusion: Tranexamic acid while significantly reducing blood loss caused by TKR surgery collaterally reduced the need for postoperative blood transfusion.
Keywords: Blood loss, total knee replacement, tranexamic acid.