This is a major problem. Work previously carried out by us some years ago confirmed the effectiveness of tranexamic acid in reducing blood loss but it was still not being used in routine practice. As well as having a direct beneficial effect on the patient as less blood is lost, it also significantly reduces the requirement for blood transfusions (a major issue for the patient and the NHS). A major study (TRAC-24) is now underway to determine if the use of oral tranexamic acid post-operatively for up to 24 hours will reduce blood loss at 48 hours for patients undergoing hip or knee replacements. This study is being funded by BART and the HSC Research & Development Division of the Public Health Agency. The Northern Ireland Clinical Trials Unit are assisting with the study and data management. A total of 1066 patients will be recruited into the study and we aim to be fully recruited by July 2018. While this study is still on-going, early results have led to a change in practice, with tranexamic acid now being used on all patients.
A jig to maintain knee flexion directly after knee replacements was developed within our unit to help reduce blood loss which is now used on all patients.