Tranexamic Acid Reduces Blood Transfusions in Revision Total Hip Arthroplasty

The use of tranexamic acid (TEA) can significantly reduce the need for allogenic blood transfusions in elective primary joint arthroplasty. Revision total hip arthroplasty (THA) requires increased utilization of postoperative blood transfusions for acute blood loss anemia compared with elective primary hip arthroplasty. There is limited literature to support the routine use of TEA in revision THA.

We performed a retrospective review of 161 consecutive patients who underwent revision THA from 2012 to 2014 at a single institution by 2 fellowship-trained surgeons. We compared the transfusion requirements and the postoperative hemoglobin drop of the TEA group (109 patients, 114 hips) vs the no-TEA group (52 patients, 56 hips). Our standard protocol for administering TEA is 1000 mg IV at incision and the same dose repeated 2 hours later. The no-TEA group did not receive the medication because of previous hospital contraindication criteria.

The transfusion rate was significantly less for the TEA group (7%) compared with the no-TEA group (34%; P < .0001). The mean hemoglobin delta was also significantly less for the TEA group (2.0 ± 1.3 g/dL) compared with the no-TEA group (3.5 ± 1.4 g/dL, P < .0001). No adverse thromboembolic events occurred in the patients who received TEA.

The routine use of TEA during revision THA demonstrated a significant reduction in allogenic blood transfusion rates. The postoperative hemoglobin drop was also significantly less with the use of TEA. We recommend the routine use of TEA during revision THA.