Reducing blood loss in simultaneous bilateral total knee arthroplasty: combined intravenous-intra-articular tranexamic acid administration. A prospective randomized controlled trial.

Background: We asked whether tranexamic acid (TXA) administration could reduce blood loss and blood transfusion requirements after simultaneous bilateral total knee arthroplasty (TKA). This study examined the role of a novel method of TXA administration in TKA.

Methods: TXA was administered as a bolus dose of 15 mg/kg 10 min before the inflation of the tourniquet on the first side. This was followed by intra-articular administration of 3 grams at 10 min before the deflation of the tourniquet. IV infusion of 10 mg/kg/h was continued for 3h following completion on the second side. We measured volume of drained blood 48 h postoperatively, decrease in hemoglobin levels 12h postoperatively, amount of blood transfused (BT), and number of patients requiring allogenic BT.

Results: Median postoperative volume of drained blood was lower in the group receiving TXA (500.00 mL) than in control subjects (900.00 mL) (p <0.05) [95% CI (-525.00) to (-300.00)]. The median hemoglobin decrease 12 h postoperatively was lower in patients receiving TXA (2.10 g/dL) than in control subjects (3.10 g/dL) (p<0.05) [95% CI (-1.60) to (-0.60)]. The amount of BT and number of patients requiring BT were lower in patients receiving TXA than in control subjects. Nevertheless, the number of allogeneic units of packed red blood cells transfused in the postoperative period was not significantly higher in the control group than in the TXA group (p=0.109) [95% CI (0.101) to (0.117)].

Conclusions: This prospective randomized study showed that during simultaneous bilateral TKA, TXA reduced blood loss with negligible side effects.