• HIMA R NAMBIAR Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
  • SHAILA S KAMATH Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.


Objective: The objective of this study was to compare the efficacy of tranexamic acid 10 mg/kg and 15 mg/kg in reducing bleeding and transfusions in total knee arthroplasty.

Methods: After approval from the Institutional Ethics Committee, KMC, Mangaluru, 88 patients fulfilling the inclusion criteria of this study undergoing total knee replacements were informed of the study details and consent was obtained for the same. They were randomized into two groups using computer-generated block randomization, i.e., Group A and Group B, and were administered tranexamic acid 10 mg/kg and 15 mg/kg intravenously, respectively. Intraoperatively, hemodynamic parameters were noted. Postoperatively, hemoglobin levels were assessed on days 1 and 3. Transfusions, thromboembolic complications, and duration of hospital stay were noted.

Results: Of the 88 participants of the trial, 44 in Groups A and B each, there were no significant differences in the parameters observed in this study such as intraoperative hemodynamic changes, post-operative fall in hemoglobin on day 3, number of patients requiring transfusions, number of thromboembolic events, and duration of hospital stay. A significant p-value was observed in the fall in hemoglobin in the post-operative day 3 (p=0.043).

Conclusion: About 15 mg/kg tranexamic acid proved to have a lesser fall in hemoglobin on day 3 postoperatively when compared to the 10 mg/kg group. However, the fall of hemoglobin on day 3 was statistically significant and warranted a blood transfusion in two patients in the 10 mg/kg group but did not prolong their hospital stay.

Keywords: Antifibrinolytics, Blood loss, Joint replacements, Blood Product Administration, Hemodynamics.


1. Healy WL, Valle CJ, Iorio R, Berend KR, Cushner FD, Dalury DF, et al. Complications of total knee arthroplasty: Standardized list and definitions of the knee society. Clin Orthop Relat Res 2013;471:215-20.
2. Crawford DC, Miller LE, Block JE. Conservative management of symptomatic knee osteoarthritis: A flawed strategy? Orthop Rev (Pavia) 2013;5:e2.
3. Van Manen MD, Nace J, Mont MA. Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners. J Am Osteopath Assoc 2012;112:709-15.
4. Weng HH, Fitzgerald J. Current issues in joint replacement surgery. Curr Opin Rheumatol 2006;18:163-9.
5. Elson DW, Brenkel IJ. Predicting pain after total knee arthroplasty. J Arthroplasty 2006;21:1047-53.
6. Al-Kubaisy W, Ali SH, Al-Thamiri D. Risk factors for asthma among primary school children in Baghdad, Iraq. Saudi Med J 2005;26:460-6.
7. Poeran J, Rasul R, Suzuki S, Danninger T, Mazumdar M, Opperer M, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: A retrospective analysis of effectiveness and safety. BMJ 2014;349:g4829.
8. Turnbull ZA, Sastow D, Giambrone GP, Tedore T. Anesthesia for the patient undergoing total knee replacement: Current status and future prospects. Local Reg Anesth 2017;10:1-7.
9. Cushner FD, Nett MP. Unanswered questions, unmet needs in venous thromboprophylaxis. Orthopedics 2009;32:62-6.
10. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 2000;7:151-5.
11. Risberg B. The response of the fibrinolytic system in trauma. Acta Chir Scand Suppl 1985;522:245-71.
12. Janssens M, Joris J, David JL, Lemaire R, Lamy M. High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery. Anesthesiology 1994;80:23-9.
13. Kruithof EK, Nicolosa G, Bachmann F. Plasminogen activator inhibitor 1: Development of a radioimmunoassay and observations on its plasma concentration during venous occlusion and after platelet aggregation. Blood 1987;70:1645-53.
14. Kambayashi J, Sakon M, Yokota M, Shiba E, Kawasaki T, Mori T, et al. Activation of coagulation and fibrinolysis during surgery, analyzed by molecular markers. Thromb Res 1990;60:157-67.
15. Petäjä J, Myllynen P, Myllylä G, Vahtera E. Fibrinolysis after application of a pneumatic tourniquet. Acta Chir Scand 1987;153:647-51.
16. Abhijit SN, Verma S. Use of tranexamic acid in megaliposuction. Int J Pharm Pharm Sci 2014;7:8.
17. Astedt B. Clinical pharmacology of tranexamic acid. Scand J Gastroenterol Suppl 1987;137:22-5.
18. Eubanks JD. Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg 2010;18:132-8.
19. Tengborn L, Blombäck M, Berntorp E. Tranexamic acid-an old drug still going strong and making a revival. Thromb Res 2015;135:231-42.
20. Dunn CJ, Goa KL. Fibrin sealant: A review of its use in surgery and endoscopy. Drugs 1999;58:863-86.
21. Reed MR, Woolley LT. Uses of tranexamic acid. Contin Educ Anaesth Crit Care Pain 2014;15:32-7.
22. Gillette BP, DeSimone LJ, Trousdale RT, Pagnano MW, Sierra RJ. Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty. Clin Orthop Relat Res 2013;471:150-4.
23. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: A prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 1996;78:434-40.
24. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 2003;90:596-9.
25. Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: Results of a meta-analysis of randomized controlled trials. Transfusion 2005;45:1302-7.
26. Marra F, Rosso F, Bruzzone M, Bonasia DE, Dettoni F, Rossi R, et al. Use of tranexamic acid in total knee arthroplasty. Joints 2016;4:202-13.
27. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S, et al. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 2001;83:702-5.
28. Orpen NM, Little C, Walker G, Crawfurd EJ. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: A prospective randomised controlled trial of 29 patients. Knee 2006;13:106-10.
29. Ralley FE, Berta D, Binns V, Howard J, Naudie DD. One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res 2010;468:1905-11.
30. Lin PC, Hsu CH, Huang CC, Chen WS, Wang JW. The blood-saving effect of tranexamic acid in minimally invasive total knee replacement: Is an additional pre-operative injection effective? J Bone Joint Surg Br 2012;94:932-6.
31. Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthroplasty: A prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 2012;470:2605-12.
32. Castro-Menéndez M, Pena-Paz S, Rocha-García F, Rodríguez-Casas N, Huici-Izco R, Montero-Viéites A, et al. Efficacy of 2 grammes of intravenous transexamic acid in the reduction of post-surgical bleeding after total hip and knee replacement. Rev Esp Cir Ortop Traumatol 2016;60:315-24.
33. Morrison RJ, Tsang B, Fishley W, Harper I, Joseph JC, Reed MR, et al. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: The effectiveness of a single pre-operative dose. Bone Joint Res 2017;6:499-505.
145 Views | 186 Downloads
How to Cite
NAMBIAR, H. R., and S. S KAMATH. “COMPARISON OF EFFICACY OF TRANEXAMIC ACID 10 MG/KG AND 15 MG/KG IN REDUCING BLEEDING AND TRANSFUSIONS IN TOTAL KNEE ARTHROPLASTY”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 12, no. 3, Mar. 2019, pp. 535-8, doi:10.22159/ajpcr.2019.v12i3.31006.
Original Article(s)