Reduction of blood loss with tranexamic acid in primary total hip replacement surgery

In this prospective, placebo-controlled, double-blind, randomized clinical trial, we investigated the effect of a single preoperative bolus dose of tranexamic acid (15 mg/kg) on perioperative blood losses and packed cell transfusion requirements in patients scheduled for primary unilateral total hip replacement surgery for degenerative osteoarthrosis.

40 patients were randomized to receive either 15 mg/kg tranexamic acid (TA group) or an equal volume of saline (placebo group) given as a single slow intravenous bolus injection 15 minutes before incision. We recorded per- and postoperative blood losses and transfusion requirements up to 24 hours postoperatively. The patients were screened for deep venous thrombosis with bilateral compression ultrasonography using colour Doppler imaging on the tenth postoperative day.

Peroperative blood loss was not significantly different between the two treatment groups (TA group : 423 ml, placebo group 516 ml ; p = 0.093). Postoperative blood loss up to 24 hrs, and total blood loss were significantly less in the TA group : 352 vs 524 ml (p = 0.013), and 801 vs 1038 ml (p = 0.013), respectively. Packed red blood cell transfusion requirements were significantly lower in the TA group (1/20 patients, total 2 units) compared to the placebo group (6/20 patients, total 13 units). Compression ultrasonography on the 10th postoperative day was positive for deep venous thrombosis in 3 patients in the TA group (17 patients screened) and negative in all patients of the placebo group (18 patients screened).

Tranexamic acid 15 mg/kg given as a single preoperative bolus dose reduces postoperative and total blood loss, and packed cell transfusion requirements in primary total hip replacement surgery.