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Background <p>Intravenous tranexamic acid (TXA) dosing regimens differ substantially across studies, varying from fixed doses (e.g., 1–2&#xa0;g) to weight-based protocols (e.g., 10–20&#xa0;mg/kg). This study aimed to compare postoperative blood loss, transfusion rates, in-hospital mortality, and complications between fixed-dose and weight-based TXA regimens in revision total knee arthroplasty (rTKA).</p> Materials and methods <p>This retrospective comparative study included 298 patients who underwent rTKA between June 2004 and May 2024. Patients were divided into three groups: (1) the no TXA group; (2) the fixed-dose TXA group, in which patients received an intravenous infusion of 1&#xa0;g TXA before skin incision and a topical application of 1&#xa0;g; and (3) the weight-based TXA group, in which patients received a weight-adjusted dose of 20&#xa0;mg/kg/h TXA intravenously and a topical application of 1&#xa0;g. We analyzed the maximum decrease in hemoglobin (Hb) levels, postoperative transfusion rate, and the incidence of in-hospital mortality and complications.</p> Results <p>The weight-based TXA group demonstrated a lower maximal decrease in Hb compared with both the no TXA (18.22&#xa0;g/L versus 26.09&#xa0;g/L, <i>p</i> &lt; 0.001) and fixed-dose TXA (18.22&#xa0;g/L versus 24.69&#xa0;g/L, p &lt; 0.001) groups. Both the fixed-dose TXA and weight-based TXA groups exhibited lower postoperative transfusion rates compared with the no TXA group (<i>p</i> &lt; 0.001). The weight-based TXA group showed a lower postoperative transfusion rate compared with the fixed-dose TXA group (<i>p</i> = 0.022). Although the incidence of deep vein thrombosis (DVT) among the three groups was statistically significant (<i>p</i> = 0.038), pairwise comparisons between groups did not reveal statistically significant differences (all <i>p</i> &gt; 0.05).</p> Conclusions <p>Weight-based dosage of TXA significantly reduced postoperative blood loss and transfusion requirements in rTKA compared with fixed-dose TXA regimen. A weight-based TXA regimen should be considered to effectively minimize postoperative blood loss and decrease transfusion requirements.</p> <p><i>Level of evidence:</i> Level 3, non-randomized observational study.</p>

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Weight-based tranexamic acid lowers the risk of postoperative blood loss and transfusion requirements compared with fixed-dose regimen in revision knee arthroplasty: a comparative study

  • 期刊论文

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  • 发表日期：

    2025年5月2日

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  • Chenchen Yang,
  • Baochao Ji,
  • Guoqing Li,
  • Xiaogang Zhang,
  • Boyong Xu,
  • Askar Maimaitiming,
  • Li Cao

摘要

Background

Intravenous tranexamic acid (TXA) dosing regimens differ substantially across studies, varying from fixed doses (e.g., 1–2 g) to weight-based protocols (e.g., 10–20 mg/kg). This study aimed to compare postoperative blood loss, transfusion rates, in-hospital mortality, and complications between fixed-dose and weight-based TXA regimens in revision total knee arthroplasty (rTKA).

Materials and methods

This retrospective comparative study included 298 patients who underwent rTKA between June 2004 and May 2024. Patients were divided into three groups: (1) the no TXA group; (2) the fixed-dose TXA group, in which patients received an intravenous infusion of 1 g TXA before skin incision and a topical application of 1 g; and (3) the weight-based TXA group, in which patients received a weight-adjusted dose of 20 mg/kg/h TXA intravenously and a topical application of 1 g. We analyzed the maximum decrease in hemoglobin (Hb) levels, postoperative transfusion rate, and the incidence of in-hospital mortality and complications.

Results

The weight-based TXA group demonstrated a lower maximal decrease in Hb compared with both the no TXA (18.22 g/L versus 26.09 g/L, p < 0.001) and fixed-dose TXA (18.22 g/L versus 24.69 g/L, p < 0.001) groups. Both the fixed-dose TXA and weight-based TXA groups exhibited lower postoperative transfusion rates compared with the no TXA group (p < 0.001). The weight-based TXA group showed a lower postoperative transfusion rate compared with the fixed-dose TXA group (p = 0.022). Although the incidence of deep vein thrombosis (DVT) among the three groups was statistically significant (p = 0.038), pairwise comparisons between groups did not reveal statistically significant differences (all p > 0.05).

Conclusions

Weight-based dosage of TXA significantly reduced postoperative blood loss and transfusion requirements in rTKA compared with fixed-dose TXA regimen. A weight-based TXA regimen should be considered to effectively minimize postoperative blood loss and decrease transfusion requirements.

Level of evidence: Level 3, non-randomized observational study.