Tranexamic Acid CAS 1197-18-8

At present, there are many clinical literatures supporting the application of tranexamic acid in total knee arthroplasty to reduce blood loss and blood transfusion rate. According to different application methods, tranexamic acid can be divided into intravenous infusion, topical application, and oral administration.

A recent systematic review found that perioperative intravenous tranexamic acid in primary total knee arthroplasty reduced blood loss by approximately 500 ml and blood transfusion by 1.43 units. Most of the studies (14/15) included in this systematic review used low doses of intravenous tranexamic acid (10-50 mg/kg), and only one study used high doses (150 mg/kg).

Topical use of tranexamic acid in joint arthroplasty is also supported by extensive literature. However, the specific dose and application method are different. Georgiadis reported that 2.0 g tranexamic acid + 75 ml normal saline was soaked in the joint cavity for 5 minutes; Chimento advocated 3 g + 100 ml normal saline soaked in the joint cavity; Mutsuzaki et al. It is recommended to dissolve 1 g of tranexamic acid in normal saline, retrogradely inject into the joint cavity through the drainage tube, and clamp the drainage tube for 1 hour. A meta-analysis concluded that topical intra-articular application of tranexamic acid above 2 g was effective in reducing postoperative blood transfusion rates.

Two studies compared topical tranexamic acid with intravenous tranexamic acid in reducing blood loss. Huang et al (1.5 g iv + 1.5 g topical application: 3.0 g iv) found similar effects; Sarzaeem et al compared three different application methods (1.5 g intravenous infusion; 3 g intra-articular immersion; 1.5 g through drainage Intra-articular injection into the joint cavity) comparison found that intravenous infusion of tranexamic acid had a better effect on reducing blood loss, and intra-articular injection had the best effect on reducing postoperative drainage.

It has also been reported in the literature that oral tranexamic acid has the effect of reducing bleeding in joint replacement surgery. Irwin compared the effect of intravenous infusion of 15 mg/kg and oral 25 mg/kg of tranexamic acid in controlling bleeding and found that oral tranexamic acid did not increase the incidence of side effects, while reducing the amount of bleeding. A randomized controlled trial completed by Alipour et al. also confirmed that oral administration of tranexamic acid 1 g 2 hours before surgery, every 6 hours after surgery, and continuously for 18 hours can effectively reduce the amount of bleeding.

Most studies on the clinical use of tranexamic acid will have a high thrombotic risk (history of stroke, previous cardiac stent implantation, previous deep vein thrombosis event, previous history of myocardial infarction, previous coronary artery bypass grafting or Thrombosis-prone diseases (such as protein C deficiency, etc.) were excluded, so it is difficult to evaluate the safety of tranexamic acid in such patients.

A study of tranexamic acid in 1102 ASA class III-IV total joint arthroplasty patients found that 240 patients at high risk of thrombosis who received tranexamic acid had a lower risk of symptomatic venous thrombosis at 30 days postoperatively. Sex did not increase. However, there are too few relevant studies, and it is difficult to draw a relatively definite conclusion on this. Therefore, some scholars suggest that topical application of tranexamic acid may be more appropriate for such patients with high risk of thrombosis.