Clinical experience with tranexamic acid during primary total hip arthroplasty

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Hematology

Background:

• Perioperative blood loss and the need for allogeneic blood transfusions are significant concerns in total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA).
• Minimizing blood loss and transfusion requirements can improve patient outcomes and reduce healthcare costs.

Purpose of the Study:

• To evaluate the efficacy of a single 1-gram preoperative dose of tranexamic acid (TXA) in reducing allogeneic blood transfusion, hemoglobin (Hb) decrease, and perioperative blood loss.
• To assess TXA's effectiveness in both primary THA and RHA procedures.

Main Methods:

• A prospective study comparing 132 patients receiving a 1-gram preoperative dose of TXA with a matched control group.
• Patients included primary THA (n=88) and RHA (n=44) with matched controls based on starting Hb, BMI, age, and gender.
• Outcomes measured included transfusion rates, Hb decrease, and perioperative blood loss.

Main Results:

• For THA, TXA significantly reduced transfusion rates from 19.3% in controls to 4.5% (p = 0.001).
• No significant difference in transfusion rates was observed for RHA patients.
• The mean Hb decrease was significantly lower in TXA groups for both THA (p<0.0001) and RHA (p = 0.01) patients.
• Overall, preoperative TXA administration significantly reduced mean Hb decrease and transfusion risk.

Conclusions:

• A single 1-gram preoperative dose of tranexamic acid is effective in reducing allogeneic blood transfusion requirements and Hb decrease in primary THA.
• TXA demonstrates a significant benefit in minimizing blood loss and transfusion risk for THA patients.
• Further investigation may be warranted for RHA patients to clarify TXA's role.