JENEL MARIAN PATRASCU, RADU PREJBEANU, VOICHITA LAZUREANU, SIMONA NITESCU, HORIA HARAGUS, GRATIAN DAMIAN, DINU VERMESAN SELECTIVE USE OF LOW DOSE TRANEXAMIC ACID IN ORTHOPEDIC SURGERY
Tranexamic acid, a synthetic derivative of lysine, is the most commonly used antifibrinolytic agent to reduce blood loss associated with surgical procedures. The regimens and routes used are highly variable. There is a current shift from systemic (intravenous) use towards topical instillation and periarticular injections. We aimed to analyze the efficacy and safety for selective use of low dose tranexamic acid in major orthopedic surgery. The use of tranexamic acid (Exacyl) was retrospectively reviewed from our Hospital’s electronic database. Over a period of 12 months, a number of 46 surgeries in 45 patients were identified, with a mean age was 66 years old. An average of 1.17 units of tranexamic acid (500mg/5mL) were used per case (range 1-3). The drug was administered immediately postoperatively and if necessary repeated once after 8-24 h. The maximum dose per administration was 10mg/kg body weight, with a mean of 7.3 (SD 1.92). The average drop in hemoglobin (from preoperative to lowest consecutive postoperative) was 2.55 (range 0.1-5.8, median 1.3). 22/46 of surgeries required transfusions, with an average of 1.8 red blood cell mass per case (range 1-4). The average duration of postoperative hospital stay was 13 days (range 7-25). There were no complications directly related to tranexamic acid administration. Even in low dose, postoperative intravenous administration of tranexamic acid reduces total blood loss and requirements for transfusion.
Key words: tranexamic acid, total knee arthroplasty, hip replacement, blood loss