Evaluation of Role of Tranexamic Acid in Reducing Blood Loss and Transfusion Rate in Patients Undergoing Lower Limb Orthopaedic Surgeries

BACKGROUND Major surgeries like hip arthroplasty, knee arthroplasty etc.; are associated with excessive bleeding. Uncontrolled bleeding can lead to increased morbidity and mortality and may necessitate blood transfusions. This prospective, randomized study was designed to evaluate the efficacy and safety of injection tranexamic acid in reducing blood loss and rate of blood transfusion in lower limb orthopaedic surgeries without tourniquet under subarachnoid block. METHODS After approval from institutional ethical committee, the study was carried out on 80 patients who were divided into two groups of 40 patients each. Patients in group T received a bolus dose of 10 mg/Kg injection tranexamic acid 10 minutes before induction of anaesthesia and patients in group C received 0.9% 10 ml normal saline. Intraoperative and postoperative blood loss were recorded and added together for total blood loss. Postoperative haemoglobin and haematocrit were evaluated 24 hrs. after surgery. The number of patients who received blood transfusion and the number of units of blood transfused postoperatively were recorded. Early adverse reactions of tranexamic acid were recorded and treated. p<0.05 was considered significant. RESULTS Mean intraoperative blood loss in group C (489.75+123.63 ml) was more than group T (450 + 138.66 ml) (p > 0.05). Postoperative blood loss was significantly less in group T (163.67 +/- 44.13 ml) as compared to group C (205.43 +/- 63.31 ml) (p<0.05). The mean total blood loss was significantly less in group T (613.67 +/- 167.40 ml) as compared to group C (695.2 +/- 162.44 ml) (p < 0.05). The drop in postoperative haemoglobin and haematocrit was significantly higher in group C as compared to group T (p < 0.0001). Significantly higher number of patients in group C (15) received postoperative blood transfusion as compared to group T (7) (p < 0.05). Acute adverse effects of tranexamic acid and complication of blood transfusion were not seen. CONCLUSIONS Injection tranexamic acid in a bolus dose of 10 mg/Kg is an effective and safe strategy to reduce blood loss and to minimise the rate of blood transfusions in lower limb orthopaedic surgeries without tourniquet under spinal anaesthesia.