[Effect of tranexamic acid on blood loss and soft-tissue swelling following cemented total hip replacement]

Tranexamic acid (TXA) is widely used during elective joint replacement to reduce blood loss and decrease the transfusion requirement.

This study assessed the efficacy of tranexamic acid in reducing minor bleeding complications following primary cemented total hip replacement, when rivaroxaban is used as thromboprophylaxis, the complicated wound healing effect of which has been published recently.

Consecutive patients undergoing hip replacement were studied. Patients receiving tranexamic acid perioperatively between January 2014 and November 2014 were designated as the TXA-group. We compared these data with those of a group of patients who underwent the same procedure between February 2012 and December 2012 (control group), before the introduction of tranexamic acid. The authors investigated the effect of tranexamic acid on surgical wound bleeding and discharge, area of hematoma on the skin surface, thigh volume changes, calculated perioperative blood loss and transfusion requirement.

168 patients, 81 in the TXA-group and 87 in the control group were included. The extent of postoperative thigh swelling was significantly less in the TXA-group, 270.3 mL (129.1-449.0) as compared with the control group, 539.8 mL (350.0-864.8, p<0.001). Tranexamic acid significantly reduced wound bleeding during the first 24 hours postoperatively (p<0.001). The amount of calculated blood loss was significantly less in the TXA-group (1150 mL [780-1496] versus 1579 mL [1313-2074] in the control group, p<0.001). Transfusion requirement was remarkably lower in the TXA-group than in the control group (15% versus 39%).

Tranexamic acid reduces postoperative thigh volume, wound bleeding and area of hematoma on the skin surface when rivaroxaban is used as the anticoagulant. Further large scale studies could help establish the clinical relevance and long-term outcome of minor bleeding complications. Orv Hetil. 2019; 160(12): 456-463.