Introduction
Blood loss during total joint replacement has serious implications on patients
affecting their ability to immediately start the postoperative enhanced recovery
program. Tranexamic acid (TA) is well known for its ability to reduce blood loss
during arthroplasty. Vitamin K has an important physiological role in the clotting
cascade, but its action is delayed and dose sensitive.
Study settings and design
A prospective comparative study conducted in Benha University Hospital.
Patients and methods
In all, 150 patients were randomly divided into three groups, each included 50
patients. Group A received both TA and vitamin K1, group B received only vitamin
K1, and group C received only TA. Perioperative blood parameters tested included
hemoglobin level, hematocrit percentage, platelet count, prothrombin time, partial
thromboplastin time, and fibrinogen level. Intraoperative and postoperative blood
losses and the amount of blood transfusion were reported. A surgeon satisfaction
score was created to assess the degree of intraoperative bleeding.
Results
The mean perioperative differences in blood parameters and amount of blood loss
were evaluated with the post-hoc test. Group A showed a statistically significant
less changes in blood parameters and less blood loss than the other groups, and
group B showed less postoperative blood losses.
Conclusion
Combined administration of TA and vitamin K with cementless total hip replacement
proved efficient in reducing intraoperative and postoperative blood losses and the
need for blood transfusion. This was reflected on the patient’s ability to start the
enhanced recovery program immediately, reduced the duration of postoperative
hospital stay, and the overall cost of operation.