Tranexamic acid attenuates inflammatory effect and modulates immune response in primary total knee arthroplasty: a randomized, placebo-controlled, pilot trial

Aims To explore the effect of intravenous tranexamic acid (IV-TXA) on inflammation and immune response following primary total knee arthroplasty (TKA). Methods Primary TKA patients (n = 125) were randomized into the following four groups: group A to receive placebo; group B to receive a single dose of 20 mg kg(-1)IV-TXA and 20 mg of intravenous dexamethasone (IV-DXM); group C to receive six doses of IV-TXA (total dosage > 6 g); and group D to receive six doses of IV-TXA combined with three doses of IV-DXM (total dosage = 40 mg). The primary outcomes were C-reactive protein (CRP) and interleukin (IL)-6 levels and the secondary outcomes were complement C3 and C4 and T-cell subset levels, which were measured preoperatively and at 24 h, 48 h, 72 h, and 2 weeks postoperatively. Results The postoperative peak CRP and IL-6 levels in group C (93.7 +/- 22.2 mg L-1, 108.8 +/- 41.7 pg mL(-1)) were lower compared with those in group A (134.7 +/- 28.8 mg L-1,P < 0.01; 161.6 +/- 64.4 pg mL(-1),P < 0.01). Groups B and D exhibited significantly lower CRP and IL-6 levels compared with groups A and C at 24 h, 48 h, and 72 h postoperatively (P < 0.05 for all). In group C, complement C3 and C4 levels were higher compared with those in group A at 48 h (0.967 +/- 0.127 g L(-1)vs. 0.792 +/- 0.100 g L-1,P < 0.01; 0.221 +/- 0.046 g L(-1)vs. 0.167 +/- 0.028 g L-1,P < 0.01) and 72 h (1.050 +/- 0.181 g L(-1)vs. 0.860 +/- 0.126 g L-1,P = 0.01; 0.240 +/- 0.052 g L(-1)vs. 0.182 +/- 0.036 g L-1,P < 0.01) postoperatively and CD3 and CD4 subset levels were higher compared with those in group B at 24 h postoperatively (66.78 +/- 9.29% vs. 56.10 +/- 12.47%,P < 0.05; 36.69 +/- 5.78% vs. 28.39 +/- 8.89%,P < 0.05). Conclusion Six doses of IV-TXA could attenuate the inflammatory effect, modulate the immune response, and reduce immunosuppression caused by DXM in patients after TKA.