Background: Approximately one-third of patients undergoing total hip replacement surgery require one to three units of blood postoperatively. Tranexamic acid is a synthetic antifibrinolytic agent that has been successfully used intravenously to control bleeding after total hip replacement. A topical application is easy to administer, provides a maximum concentration of tranexamic acid at the bleeding site, and is associated with little or no systemic absorption of the tranexamic acid.
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The Journal Of Bone & Joint Surgery - Scientific Articles: 06 November 2013 - Volume 95 - Issue 21 - p. 1969-1974
Hip
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Topical (Intra-Articular) Tranexamic Acid Reduces Blood Loss and Transfusion Rates Following Total Hip Replacement
Alshryda Sattar, MBChB, MRCS, MRCSEd, FRCS(Tr&Orth), PhD; Mason James, DPhil, MSc, BSc(Hons); Sarda Praveen, MBBS, MRCS, FRCS(Tr&Orth); Nargol Antoni, MBBS, FRCS, FRCS(Tr&Orth); Cooke Nick, FRCS(Tr&Orth); Ahmad Hafeez, FRCS; Tang S., FRCS; Logishetty Raj, MBBS, FRCS, FRCS(Tr&Orth); Vaghela Manesh, MBBS, MS, MSc; Mcpartlin Lynne, BSc(SCP), Diploma(ODP); Hungin A. Pali S., MD, FRCGP, FRCP, FRSAHip
Methods: A double-blind, randomized controlled trial of 161 patients undergoing unilateral primary total hip replacement investigated the effect of topical (intra-articular) application of tranexamic acid on blood loss. The primary outcome was the blood transfusion rate. Secondary outcomes included the drain blood loss, hemoglobin concentration drop, generic quality of life (EuroQol), Oxford Hip Score, length of stay, a cost analysis, and complications.
Results: Tranexamic acid reduced the absolute risk of blood transfusion by 19.6% (95% confidence interval [CI], 6.9% to 32.1%; p = 0.004), from 32.1% to 12.5%, and reduced blood loss by 129 mL (95% CI, 47 to 211 mL; p = 0.002), the hemoglobin concentration drop by 0.84 g/dL (95% CI, 0.41 to 1.27; p < 0.0001), the length of stay by 1.0 days (95% CI, −0.2 to 2.3 days; p = 0.109), and the cost per episode by £305 (95% CI, £0 to £610; p = 0.05). (In 2010, £1 = 1.5 U.S. dollars.) Oxford Hip Scores and EuroQol scores were similar at three months.
Conclusions: Topically applied tranexamic acid was effective in reducing blood loss and the need for blood transfusion following total hip replacement, avoiding the potential complications of intravenous tranexamic acid administration.
Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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