To compare the effection and safety of intra-articular injection for tranexamic acid(TXA) versus hemocoagulase(HCA) by reducing blood loss after total knee arthroplasty(TKA).

From February 2012 to June 2015, 120 patients suffered knee osteoarthritis accepted unilateral TKA. The patients with preoperative hemoglobin<95 g/L, blood system disease, combined history of myocardial infarction, atrial fibrillation, pacemaker installation, venous thrombosis, and renal insufficiency were excluded. The enrolled patients were divided into three groups: group A (TXA group) enrolled 40 cases (2g TXA with 100ml normal saline which was injected into the articular cavity through the drainage tube); group B (HCA group) enrolled 40 cases(four units HCA with 100ml normal saline injection using the same method); group C (NS group) enrolled 40 cases (100 ml normal saline injection by the same method). The blood routine, blood coagulation and D-dimer were rechecked on the 1^st , 3^rd and 5^th day postoperatively. The postoperative drainage volume, total blood loss, hemoglobin(Hb) values on 1^st , 3^rd and 5^th day postoperatively, blood transfusion, the rate of deep vein thrombosis and incision infection were recorded. F test was used to analyze the drainage volume, total blood loss, hidden blood loss and Hb values among the groups; χ² test was used to analyze the blood transfusion, the incidence of venous thrombosis and pulmonary embolism.

There were two cases of blood transfusions in the TXA group, three cases in the HCA group, 12 cases in the NS group, and significant differences were found between the HCA group/ NS group and the TXA group/ NS group (F=12.33, F=13.45 , P<0.01)while there was no significant differences between the HCA group and the TXA group (F=1.08 , P >0.05). HCA group and TXA group were compared with NS group for the drainage volume at 6 h (F=9.320)and 24 h (F=12.15)postoperatively, the hidden blood loss(F=9.450, F=8.650, F=7.885) and total blood loss(F=6.334, F=7.898, F=6.167) on the 1^st, 3^rd and 5^th day postoperatively showed significant difference (P<0.05)while no statistical difference was found between HCA group and TXA group (P>0.05). Hb values(F=6.300, F=8.470, F=10.56)and △Hb values(F=13.35, F=17.76, F=16.33)on the 1^st , 3^rd and 5^th day postoperatively in HCA group and TXA group compared with those in NS group showed significant difference(P<0.05); while no statistical difference was found between HCA group and TXA group (P>0.05). Two cases in TXA group , three cases in the HCA group and one case in the NS group occured calf muscular venous thrombosis; serious complications such as myocardial infarction, cerebral infarction, pulmonary infarction did not appear. No significant difference was observed among the groups in the thrombus incidence (F=1.4, P >0.05). The fat liquefaction of surgical incision occurred in all three groups, including three patients in the TXA group, two patients in the HCA group and four patients in the NS group.

Intra-articular injection of HCA or TXA and clipping the drainage tube for 3 h postoperatively can effectively reduce postoperative drainage volume, recessive blood loss and total blood loss on the postoperative first day and these managements would not increase the incidence of deep vein thrombosis and incision poor healing rate.