Estudo comparativo com uso do ácido tranexamico tópico e intravenoso em rela??o à perda sanguínea na artroplastia total do joelho

摘要

Objective To compare topical vs. intravenous tranexamic acid (TA) in total knee arthroplasty regarding blood loss and transfusion. Methods Ninety patients were randomized to receive TA intravenously (20 mg/kg in 100 mL of saline; IV group), topically (1.5 g in 50 mL of saline, sprayed over the operated site, before release of the tourniquet; topical group), or intravenous saline (100 mL with anesthesia; control group). The volume of drained blood in 48 h, the amount of transfused blood, and the serum levels of hemoglobin and hematocrit before and after surgery were evaluated. Results The groups were similar for sex, age, weight, laterality, and preoperative hemoglobin and hematocrit levels (p > 0.2). The hemoglobin level dropped in all groups when comparing the preoperative and the 48‐hour evaluations: the control group decreased 3.8 mg/dL on average, while the IV group had a decrease of 3.0, and the topical group, of 3.2 (p = 0.019). The difference between the control and IV groups was confirmed by Bonferroni test (p = 0.020). The difference between the control group and the topical group was not significant (p = 0.130), although there was less reduction in hemoglobin in the topical group; the comparison between the IV group and the topical group was also not significant (p = 1.000). Conclusion Using tranexamic acid topic and an IV decreased blood loss and the need for transfusion in total knee arthroplasty. Topical application showed results similar to using an IV regarding the need for blood transfusion, but without the possible side effects of IV administration.