Perioperative blood loss of sequential administration of hemocoagulase Agkistrodon and Tranexamic acid for primary total knee arthroplasty: a randomized controlled trial.

PURPOSE: Total knee arthroplasty (TKA) has significant perioperative blood loss and a high transfusion rate. Tranexamic acid (TXA) has widely recognized hemostatic efficacy in TKA. Hemocoagulase Agkistrodon (HCA) enhances coagulation by hydrolyzing fibrinogen into fibrin, complements the hemostatic effect of TXA. Our aim was to investigate the hemostatic potential of sequential administration of HCA and TXA in TKA. METHODS: Patients who underwent cemented total knee arthroplasty at our hospital were randomized to receive the sequential administration of HCA and TXA (n = 29) or TXA-only (n = 30. All patients received mechanical and chemical thromboprophylaxis protocol. The primary outcome was perioperative blood loss, while secondary outcomes were postoperative coagulation function and arterio-venous thrombosis, transfusion, and complications. RESULTS: Total blood loss was not different between sequential administration of HCA and TXA group (1,025.3 ± 305.3 mL) and TXA-only group (892.4 ± 306.4 mL, P = 0.079). Intermuscular vein thrombosis was reported in one case in the sequential administration group and three cases in the TXA-only group. No deep vein thrombosis was reported in any of the patients. The two groups had no perioperative transfusion. CONCLUSION: The sequential administration of HCA and TXA does not demonstrate superior efficacy in reducing blood loss compared to TXA-only. However, the HCA and TXA group has a lower incidence of intermuscular thrombosis and may demonstrate superiority in postoperative thromboprophylaxis.