Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Orthopedic Surgery

Introduction: Extensive blood loss related to knee arthroplasty is quite normal and many patients require blood transfusions. Surgery and the use of pneumatic tourniquets lead to an increase in the activity of the fibrinolytic system, which in turn may accentuate the blood loss. Drugs that inhibit the fibrinolytic system may thus be used to reduce blood loss. Tranexamic acid (TXA) acts by binding to one of the enzymes at the start of the coagulation cascade, so inhibiting the fibrinolytic system. A concern is that this inhibition may have the side effect of increasing thromboembolic disease, a common complication of joint replacement surgery. I aimed to confirm the reductions in blood loss and to assess the impact of the use of topical TXA usage on clinical and sub-clinical DVT. Method: A prospective, randomized, controlled trial was performed, using patients who underwent primary unilateral total knee arthroplasty. Patients were randomized to receive either [1gm of tranexamic acid (10 ml) added to 40 ml saline] or a similar volume of normal saline (50 ml) after closure of the joint capsule just before the deflation of the tourniquet, and drain clamped for 2 hours, Blood loss in the drain was recorded 48 hours after surgery, also Hg is measured pre-operative and 48 hours postoperatively. Results: A statistically highly significant decrease in blood loss in the early post-operative period was noted in the group receiving tranexamic acid. Also highly statistically significant difference between preoperative and postoperative according to Hb in each group. Less Hg level decrease postoperatively in the group injected with tranexamic acid

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