Blood Loss Control with Two Doses of Tranexamic Acid in a Multimodal Protocol for Total Knee Arthroplasty

Miguel Ortega-Andreu 1, Hanna Pérez-Chrzanowska 2, Reyes Figueredo 2, Enrique Gómez-Barrena*, 1, 3
1 Department of Orthopaedics “A”, La Paz Hospital at Cantoblanco, Madrid, Spain
2 Department of Anaesthesiology, La Paz Hospital at Cantoblanco, Madrid, Spain
3 Facultad de Medicina, Universidad Autónoma de Madrid, 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 License ( 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 Servicio de Cirugía Ortopédica y Traumatología “A”, Hospital de Cantoblanco, Carretera de Colmenar Viejo, Km 14,500, Madrid 28049, Spain; Tel/Fax: +34914269774; E-mail:


Average blood loss after total knee arthroplasty (TKA) usually ranges from 1500 to 1900 cc, including both the postoperative drain and hidden blood loss. This represents about 46% of TKA patients requiring postoperative blood transfusion. Not only the risks of disease transmission but also those of ABO incompatibility, infection due to immunosupression, increased procedure costs, and increased length of hospital stay, are potential problems that foster blood saving strategies. In this study, 71 unilateral TKAs using a multimodal protocol to decrease blood loss were compared to 61 historical cases. Patients in both groups underwent cemented TKA with the same system, surgical technique, and multimodal protocol (MIS approach, plug in the femoral canal, tourniquet removal after wound closure and compressive bandage, analgesic periarticular infiltration with vasoconstrictor, postoperative drain at atmospheric pressure, opened 2 hours after the end of the surgical procedure and removed after 24 hours). The study series incorporated intravenous tranexamic acid (TXA) infusion in 2 doses of 10-15 mg/kg, 15 minutes before tourniquet release and 3 hours later. Results showed no transfusion requirements in the TXA series (0%), with 23/61 (37.7%) transfusions in the control, with an average cost decrease of 240 euros per patient. Visible bleeding in 24h significantly decreased from 553.36 cc (range 50-1500) to 169.72 cc (range 10-480) in the TXA series. As a conclusion, implementing a TXA-based multimodal protocol produced significant decrease in the transfusion rate, visible blood loss, and cost per patient, thus proving effectiveness and efficiency in the surgical management of TKA.

Keywords: Blood saving surgery, transfusion rate, TKA, tranexamic acid, effectiveness.