Efficacy of IV tranexamic acid versus autologous blood salvage systems in controlling blood loss following knee arthroplasty

The purpose of this study is evaluate and compare efficacy of tranexamic acid (TXA) versus autologous blood salvage systems in blood loss management following primary total knee arthroplasty (TKA). Observational, prospective, randomized study performed between April 2016 and June 2017. 120 consecutive patients who underwent TKA were divided into three 40-patient groups: Group A, with one drain and a blood salvage system; Group B, with two drains and a blood salvage system; and Group C, with IV TXA and one drain without a blood salvage system. Principal outcomes included hemoglobin (Hb) and hematocrit (Htc) decreases 24 hours after surgery and need for transfusion. The mean decrease in Hb levels was 2.96 +/- 1.17 g/dL in A, 3.05 +/- 0.99 g/dL in B, and 1.79 +/- 0.77 g/dL in C. The mean decrease in Htc levels was 9.19 +/- 3.7% in A, 9.49 +/- 3.2% in B, and 5.57 +/- 2.1% in C. We found statistically-significant differences between Group C versus A and B (P=0.002, P=0.004) and among the groups individually: C vs A (P=0.012) and C vs B (P=0.003) in hemoglobin levels; C vs A (P=0.022) and C vs B (P=0.007) in hematocrit levels. There were no significant differences between A and B. Three patients in A (50%) and 3 in B (50%) needed transfusions. No patients in C required transfusion, but this was not statistically significant with respect to the other groups (P=0.206). As conclussions, TXA significantly reduces decreases in hemoglobin and hematocrit levels following TKA compared to blood salvage drains. For blood salvage systems, there is no difference between using one or two drains.