Prevention of bleeding in total hip and knee replacement: Contribution of combined route in tranexamic acid...

Tranexamic acid (TXA) has revolutionized perioperative blood management of total hip (THA) and knee arthroplasties (TKA). However, there is currently no consensus on the optimal administration route.

To compare the combined administration of TXA (intravenously (IV) and topically) versus IV alone on the reduction of postoperative bleeding in THA and TKA.

A nine-month double-blind randomized trial was conducted. Adult consenting patients scheduled for primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) were included. The primary outcome measure was the decrease in hemoglobin levels 24 hours after surgery. They were randomized either to the IV group (51 patients) receiving 2 doses of 1 g of IV TXA 3 hours apart, or to the Combined group (50 patients) receiving 1 g of IV TXA and a topical dose of 1.5 g.

The mean decrease in hemoglobin 24 hours after surgery was similar for both groups in THA (p=0.91) and TKA (p=0.19). There was no difference in perioperative transfusion rate between the two THA groups (p=0.6). In TKA, no perioperative transfusion was required. Total and measured blood losses were similar in both groups. Immediate and 3-month postoperative complications were similar.

Compared to IV TXA alone, the combined route does not reduce the risk of bleeding in prosthetic surgery.