Tranexamic Acid in a Multimodal Blood Loss Prevention Protocol to Decrease Blood Loss in Revision Total Knee Arthroplasty: A Cohort Study#

Miguel Ortega-Andreu1, Gloria Talavera1, Norma G. Padilla-Eguiluz2, Hanna Perez-Chrzanowska3, Reyes Figueredo-Galve3, Carlos E. Rodriguez-Merchán2, Enrique Gómez-Barrena2, *
1 Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-Cantoblanco, Madrid, Spain
2 Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPAZ-UAM, Madrid, Spain
3 Department of Orthopaedic Anaesthesiology, Hospital La Paz-Cantoblanco, Madrid, Spain

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© Ortega-Andreu et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Hospital de Traumatología 1ª planta, Hospital Universitario “La Paz”, Pº Castellana 261, 28046 Madrid, Spain; Tel: +34.917277085; Fax: +34.917277085; E-mail:



To clarify if blood loss and transfusion requirements can be decreased in revision knee surgery through a multimodal blood loss approach with tranexamic acid (TXA)

Patients and Methods:

A retrospective study was designed in 87 knees (79 patients) that received a knee revision between 2007 and 2013. To avoid heterogeneity in the surgical technique, only revisions with one single implant system were included. A treatment series of 44 knees that received TXA and other techniques in a multimodal blood loss protocol was compared to a control series of 43 knees that received neither TXA nor the rest of the multimodal blood loss protocol. No differences in the complexity of surgeries or case severity were detected.


A significant decrease was observed from 58% transfusion rate in the control group to 5% in the treated group. The postoperative haemoglobin drop was also significantly different. Although the use of a blood loss prevention approach including TXA was the most relevant factor in the transfusion risk (OR=15), longer surgical time also associated an increased risk of transfusion (OR=1.15).


This study supports the use of a two-dose intravenous TXA under a multimodal blood loss prevention approach in revision knee replacement with significant reduction in the transfusion rate, postoperative blood loss and haemoglobin drop.

Keywords: Blood loss, Blood saving protocol, Haemoglobin drop, Multimodal protocol, Revision knee replacement, Revision total knee replacement, Tranexamic acid, Transfusion rate.