Reducing Blood Loss by Intravenous Tranexamic Acid in Minimally Invasive Total Knee Arthroplasty for Geriatric Patients

Background: Reducing blood loss is an important issue in total knee arthroplasty (TKA), especially for geriatric patients, who are often less tolerable to anemia. Tranexamic acid (TXA) is a widely studied agent to reduce blood loss in TKA. The safety and efficacy has been proved. Minimally invasive total knee arthroplasty (MIS-TKA), as a subgroup of the TKA, was believed to have the same benefit from the TXA, although direct investigation was not much. In this study, we aimed to confirm the efficacy and safety of TXA in the MIS-TKA. Methods: We reviewed a series of 64 primary MIS-TKA procedures performed by a single surgeon from March 2013 to June 2013. The patients was divided into two groups according to the usage of TXA during operation or not. The hemoglobin, blood loss amount from drainage, amount of blood transfusion needed, hospital stay and complications were recorded and compared. Results: The total blood loss amount from drains in postoperative two days was significantly lower in TXA group then control group (p < 0.001). The postoperative decrease in hemoglobin and transfusion rates were also significantly less in TXA group then control group (p = 0.001, 0.03 respectively). There was no symptomatic venous thromboembolism event or other major adverse event in either group. Conclusion: Intravenous TXA significantly reduced blood loss and transfusion rate without increasing the risk of complications in MIS-TKA. The efficacy and safety of TXA in MIS-TKA appears to be as good as in conventional TKA and make it safer for geriatric patients undergoing MIS-TKA. Copyright (C) 2019, Taiwan Society of Geriatric Emergency & Critical Care Medicine.