Abstract
Objective: The drain-clamping (DC) method using intraarticular tranexamic acid (TA) administration is reportedly effective for controlling bleeding after total knee arthroplasty (TKA). However, there is concern that this method causes venous thromboembolism (VTE) and that a resulting thrombus may stabilize and persist without degradation. This study aimed to examine the efficacy of the DC method with TA administration and its influence on VTE.
Methods: We studied 52 knees in 48 patients who underwent TKA and in whom contrast-enhanced computed tomography (CT) was carried out on postoperative days 1 and 14 at our artificial joint center between January 2009 and January 2010. The TA group consisted of 42 knees treated by the DC method with intraarticular administration of 1000 mg TA and 20 ml physiological saline via the drain after surgical wound closure. The non-TA group consisted of 10 knees treated by the DC method without TA administration. In both groups, the drain was clamped for 3 h and then unclamped. VTE was diagnosed using contrast-enhanced CT. Total blood loss, VTE incidence, and thrombus persistence from postoperative days 1 to 14 were evaluated.
Results: Total blood loss was 516±228 ml in the TA group and 973±284 ml in the non-TA group; the blood loss was significantly lower in the former group. VTE incidence was 50% in the TA group and 40% in the non-TA group on postoperative day 1 and 38% and 50%, respectively, on postoperative day 14. Thrombus persistence was 57.1% in the TA and 100% in the non-TA group. Thrombus persistence was actually lower in the TA group, i.e., TA had no apparent adverse effect on thrombus persistence.
Conclusion: The DC method with TA may be useful for its sufficient hemostatic effect and it has a minimal effect on the incidence or persistence of VTE.
