Evaluation of the use of multiple doses of tranexamic acid on blood loss in total knee arthroplasty

Total knee arthroplasty (TKA) is related to significant perioperative bleeding that can lead to complications related to blood loss and blood transfusion when necessary. Intravenous (IV) administration of tranexamic acid (ATX) has shown good results in reducing visible blood loss in TKA. The main objective of the study was to evaluate the effect of multiple-dose ATX use on blood loss in TKA. Prospectively and randomly, 60 participants of both sexes over 50 years of age, admitted to INTO for cemented TKA from August 2017 to May 2018, were evaluated. They were divided into three groups, with 20 patients each, according to the intervention: Group I, composed of patients who received the IV dose of 15mg / kg ATX 30 minutes before surgery and 8/8 hours (h) for 24h postoperatively; Group II consisted of patients receiving ATX only in the preoperative form IV of 15mg / kg in a single dose 30 minutes before surgery; Group III, control, composed of patients who received no dose of ATX. Regarding the results, the groups were homogeneous regarding gender, age, weight, preoperative hemoglobin (Hb) and blood volume. There was no significant difference between groups I and II in relation to the control group regarding the loss of Hb at 24 and 48h. Regarding the estimated blood loss at 24 and 48h, only group II had less loss compared to the control group, although the losses in groups I and II were not significantly different. There was a significant difference regarding the blood loss assessed by the drain in the intervention groups, where groups I and II had a smaller volume collected compared to group III. We conclude that the use of ATX in one and multiple doses, used in TKA performed with ischemia and revision of hemostasis, was effective in reducing the visible losses measured in the drain. However, the use of multiple doses of ATX was not superior to the use of a single dose in reducing the drop in postoperative Hb levels and reducing blood loss in TKA. The use of multiple doses did not correlate with increased thromboembolic complications