Abstract
INTRODUCTION: although blood-sparing properties of tranexamic acid (TA) and desmopressin (Desmo) have been well described following various surgical procedures, few studies have compared the effect of Desmo to that of TA in total knee arthroplasty (TKA). The purpose of our study was to compare the effectiveness of TA and Desmo in reducing perioperative bleeding during TKA. METHODS: we conducted a prospective double-blind study including patients undergoing TKA under spinal anesthesia, randomized into 2 groups: the Desmo group (patients received 0.3 μg/kg of Desmo in 100 ml of saline over 30 minutes before incision, followed by a saline infusion of 30 ml/kg over 12 hours) and the TA group (patients received 20 mg/kg of TA in 100 ml of saline over 30 minutes before incision, followed by 10 mg/kg of TA in 30 ml/kg of saline over 12 hours). The endpoints were perioperative bleeding, transfusion requirement and postoperative complications. RESULTS: the study included 55 patients divided into 2 groups: TA group (28 patients) and Desmo group (27 patients). Blood accumulation in the jar during the procedure was significantly higher in the TA group (339±40 ml) than in the Desmo group (295±77 ml) (p=0.038). During the first 12 postoperative hours, additional blood accumulation in the redon was significantly higher in the Desmo group (h6: 288±55ml, H12: 383±63ml) compared to the TA group (h6: 188±42ml, h12: 287±60ml) with at H6: p= 0.001 and at H 12: p= 0.009. After 12 hours postoperatively, blood volume in the redon became similar in the 2 groups. From the time of discharge from the post-interventional monitoring room (PICU) to 2 days postoperatively, hemoglobin and hematocrit levels were similar in the 2 groups. Platelet count (PLT) was significantly higher in the Desmo group than in the TA group upon leaving the PICU (Pq desmo: 193929±25000 vs Pq AT: 157370±24300; p< 0.001) and on postoperative day 1 (Pq desmo: 178929±26200 vs Pq AT: 168929±25100; p= 0.048). By postoperative day 2, platelet counts became similar in the 2 groups. During the postoperative period, only one patient in the Desmo group required an allogeneic blood transfusion. No postoperative thromboembolic events were noted in our patients. CONCLUSION: both TA and desmopressin are comparably effective in reducing perioperative blood loss during TKA under spinal anesthesia.