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Clin Orthop Relat Res. 2011 Apr 22;:   21512813 

Tranexamic Acid Reduces Blood Loss and Blood Transfusion after TKA: A Prospective Randomized Controlled Trial.
[My paper] Keerati Charoencholvanich, Pichet Siriwattanasakul
Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok, 10700, Thailand, KeeratiC@hotmail.com.
BACKGROUND:TKA may be associated with considerable blood loss, and transfusion carries substantial risk of immunologic reaction and disease transmission. Blood transfusion also involves additional cost, therefore a reduction in its use is important. Several methods reportedly reduce postoperative blood loss and avoid homologous blood transfusion with traditional TKA approaches, but it is unclear thesereductions apply to a minimally invasive technique. QUESTIONS/PURPOSES: We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after TKA. PATIENTS AND METHODS: Between March 2008 and May 2008, we enrolled 100 patients with primary osteoarthritis undergoing a unilateral cemented TKA in a prospective, randomized, double-blind study. Patients wererandomized into one of two groups: the control group received a placebo and the study group received tranexamic acid intravenously (10 mg/kg) 10 minutes before inflation of the tourniquet and 3 hours postoperatively and orally (250 mg/capsule; two capsules three times daily) for 5 days. We measured volume of drained blood 48 hours postoperatively, decrease in hemoglobin levels 12 hours postoperatively,amount of blood transfused, and number of patients requiring allogenic blood transfusion. The minimum followup was 6 months (mean, 10.4 months; range, 6-12 months). RESULTS: Mean (± SD) postoperative volume of drained blood was lower in the group receiving tranexamic acid (727.50 ± 234 mL) than in control subjects (1208.77 ± 421 mL). The mean hemoglobin decrease 12 hours postoperatively was lower inpatients receiving tranexamic acid (2.12 ± 0.64 g/dL) than in control subjects (3.33 ± 0.88 g/dL). The amount of blood transfused and number of patients requiring blood transfusion were lower in patients receiving tranexamic acid than in control subjects. CONCLUSIONS: Tranexamic acid reduced postoperative blood loss after TKA, as reflected in reduction in the number of blood transfusions. We didnot observe any change in symptomatic thromboembolic phenomenon. LEVEL OF EVIDENCE: Level 1, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Keywords: tka; tranexamic; tranexamic acid; transfusion; blood; blood transfusion; after tka; blood loss; acid; hour postoperatively; loss; reduce blood; transfusion after; drain blood; acid reduce; 

JArthroplasty. 2011 Mar 22;:   21435821 
Risk of Deep Venous Thrombosis in Drain Clamping With Tranexamic Acid and Carbazochrome Sodium Sulfonate Hydrate in Total Knee Arthroplasty.
[My paper] Tomohiro Onodera, Tokifumi Majima, Naohiro Sawaguchi, Yasuhiko Kasahara, Takayuki Ishigaki, Akio Minami
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.The aim of this randomized prospective study was to clarify risks associated with a drain-clamping method using tranexamic acid and carbazochrome sodium sulfonate hydrate after total knee arthroplasty (TKA). Subjects comprised 100 patients scheduled to undergo TKA, randomized into 2 groups: 50 patients received the drain-clamping method using tranexamic acid and carbazochrome sodium sulfonatehydrate and 50 patients received drain-clamping with saline. Although bleeding volume was significantly lower in the group with tranexamic acid and carbazochrome sodium sulfonate hydrate, risk of asymptomatic deep venous thrombosis as detected by ultrasonography was comparable between groups. Tranexamic acid and carbazochrome sodium sulfonate hydrate in the drain-clamping method help reduce bleeding...