Topical Application of Tranexamic Acid Plus Diluted Epinephrine Reduces Postoperative Hidden Blood Loss in Total Hip Arthroplasty

We evaluated the efficacy and safety of topical application of tranexamic acid (TXA) plus diluted epinephrine (DEP) and its effect on perioperative hidden blood loss and transfusion requirement in primary unilateral total hip arthroplasty (THA). We randomized 107 patients undergoing THA into two groups: 53 received intra-articular TXA 3 g plus 1:200,000 DEP 0.25 mg; 54 received topical TXA 3 g alone. Results showed that combined administration significantly reduced total blood loss (P = 0.009), hidden blood loss (P = 0.001) and transfusion rate (1.9 vs. 9.3%) compared with TXA alone, without increasing the risks of thromboembolic and hemodynamic complications. Topical TXA plus DEP in THA can decrease postoperative hidden blood loss and avoid homologous transfusion without substantial complications.