A retrospective investigation of the effect of tranexamic acid application and tourniquet duration on postoperative bleeding amount in patients undergoing total knee arthroplasty

Abstract

Objectives: It is aimed to investigate the effect of tourniquet and tranexamic acid (TXA) on the amount of perioperative bleeding in patients undergoing total knee arthroplasty.Methods: One hundred and ninety-three patients included in the study. The patients included in the study were divided into 4 groups. Group 1 (n = 78) was determined as the patient group with long-term tourniquet application, but without additional application and was accepted as the control group. Group 2 (n = 40) was the long-term tourniquet and intravenous (IV) TXA applied group, Group 3 (n = 40) was the long-term tourniquet and intra-articular TXA applied group, and Group 4 (n = 35) was the short-term tourniquet (only in the cementing phase) and IV TXA applied group. The difference between groups according to use of a tourniquet during the operation, the method and dose of TXA, the amount of postoperative blood transfusion, the amount of drained blood, the length of hospital stay, and complications were investigated.Results: The largest Hemoglobin (Hb) and Hematocrit (Hct) decreases were found in Group 1 (3.39 ± 0.92 g/dl and 10.8%, respectively). Also the highest drainage (median 350 ml), transfusion (16.7%), length of hospital stay (mean 4.51 ± 1.07 days) and estimated blood loss (median 1559.8 ml) were in Group 1 (p < 0.05). The lowest Hb decrease (mean 2.95 ± 0.68 g/dl) and lowest drainage (median 150 ml) was seen in group 3 and the lowest length of hospital stay (mean 3.89 ± 0.8 days) in group 4 (p < 0.05).Conclusions: The use of TXA was shown to lead to a reduction in Hb and Hct, the amount of blood drained after surgery, and the length of hospital stay. The use of TXA may be a good option for bleeding control in patients undergoing total knee arthroplasty.