A comparative study of the postoperative allogeneicblood‐sparing effects of tranexamic acid and of desmopressin after total knee replacement

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Abstract
BACKGROUND: Tissue hypoxia and reperfusion induce abnormal hemostatic function. Therefore, bleeding after total knee replacement (TKR) may be a result of a tourniquet‐induced imbalance of the procoagulant and fibrinolytic systems. Because laboratory confirmation of tourniquet‐induced abnormal hemostasis is difficult to obtain, indirect evidence must be sought.STUDY DESIGN AND METHODS: A prospective, single‐blind study of 40 patients undergoing TKR was performed. In the tranexamic acid (TA) group, in the 30 minutes before the limb tourniquet was deflated, an IV bolus dose of TA (15 mg/kg) was administered. Thereafter, a constant IV infusion of 10 mg per kg per hour was administered until 12 hours after tourniquet deflation. In the desmopressin group, desmopressin (0.3 mg/kg) and saline were administered by a similar protocol. No blood was administered intraoperatively. A postoperative Hct RESULTS: During the first 12 postoperative hours, blood accumulation in the surgical drain was significantly (pCONCLUSION: TA induces better blood sparing than desmopressin. Therefore, a tourniquet‐induced increase in fibrinolysis is the likely cause of delayed bleeding after TKR surgery. However, before routine administration, the effect of TA on the incidence of thromboembolic events requires further investigation.

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