Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

Abstract

Background We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA). Methods For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50–75\u2009years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1\u2009g IV-TXA 10\u2009min before skin incision, followed by articular injection of 1.5\u2009g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1\u2009g) for 3\u2009h (group A) or three doses of IV-TXA (1\u2009g) for 3, 6, and 12\u2009h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay. Results The mean TBL, HBL, and maximum Hb level decrease in group B (506.1\u2009±\u2009227.0\u2009mL, 471.6\u2009±\u2009224.0\u2009mL, and 17.5\u2009±\u20097.7\u2009g/L, respectively) were significantly lower than those in group A (608.8\u2009±\u2009244.8\u2009mL, P \u2009=\u20090.035; 574.0\u2009±\u2009242.3\u2009mL, P \u2009=\u20090.033; and 23.42\u2009±\u20099.2\u2009g/L, P\u2009= \xa00.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 ( P \u2009<\u2009\xa00.001), and the incidence of thromboembolic events was similar between the groups ( P \u2009>\u20090.05). Conclusion In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA. Trial registration The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR1900025013 ).