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Objectives and questions: The prevalence of preoperative anemia in patients undergoing total knee arthroplasty (TKA) ranges from 10% to 20%. Anemia significantly increases the frequency of blood transfusions, increases the risk of various complications, negatively affects functional outcome, and prolongs hospital stay. Antifibrinolytics are widely used to reduce blood loss after TKA, but drug selection and dosing remain challenging. The aim of this study was to determine the efficacy of antifibrinolytic agents in TKA in patients with preoperative anemia.

Material and methods: A prospective comparative randomized study was conducted, including 90 patients who underwent TKA. All patients had mild to moderate anemia at preoperative stage. Patients in the group 1 (n=30) received aminocaproic acid (50 mg/ml solution) at a dosage of 100 mg/kg (intravenous) before the surgery with topical intra-articular application at the end of surgery. Patients in the group 2 (n=30) received tranexamic acid at a dosage of 1 g (intravenous) before the surgery with topical intra-articular application at the end of surgery. Patients in the group 3 (n=30) did not receive antifibrinolytics. The volume of perioperative blood loss, hemoglobin level, and number of blood transfusions in the postoperative period were assessed. Statistical analysis of the data was performed using the “Statistica” software. Nonparametric analysis methods were used, including the Mann-Whitney and Kruskal-Wallis tests. The study data are presented as the mean [confidence interval 95%]. A statistical significance level of p<0.05 was taken.

Results: Perioperative blood loss was statistically greater in group 3 – 924 ml [815;1098] than in group 1 – 698 ml [592;787] and group 2 – 725 ml [612;802] (p<0.001). Postoperative hemoglobin levels were statistically significantly higher in group 1 – 9.4 g/dL [9.2;9.5] and group 2 – 9.3 g/dL [9.1;9.5] than group 3 – 8.9 g/dL [8.7;9.1] (p<0.001). No statistically significant differences were found between group 1 and group 2 in blood loss and postoperative hemoglobin levels (p>0.05). In group 3, 5 (16.7%) patients required transfusions of donor blood components.

Discussion and conclusions: The use of antifibrinolytics in TKA in patients with preoperative anemia significantly reduces the volume of perioperative blood loss, reduces the need for blood transfusion and creates favorable conditions for early active rehabilitation of the patient.