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Weight-Based Tranexamic Acid Is More Effective in Reducing Postoperative Blood Loss Compared to a Fixed-Dose Regimen
Chenchen Yang1, Baochao Ji1, Guoqing Li1
1Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, Urumqi, Xinjiang, 830054, China; Xinjiang Clinical Research Center for Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Background:
The optimal dose of intravenous tranexamic acid (TXA) for surgical use remains uncertain. This study aimed to compare the postoperative blood loss, perioperative transfusion rate, in-hospital mortality, and complications between fixed-dose and weight-based TXA regimens in revision total hip arthroplasty (rTHA).
Methods:
We conducted a retrospective comparative analysis of 377 patients who underwent rTHA between March 2004 and March 2024, categorizing them into three groups based on the TXA regimen: (1) the no-TXA group; (2) the fixed-dose TXA group, who received one gram of intravenous TXA before skin incision, with an additional one gram of topical TXA; and (3) the weight-based TXA group, who received a weight-adjusted dose of 20 mg/kg/h of intravenous TXA before skin incision, with an additional one gram of topical TXA. The maximal decrease in hemoglobin, perioperative transfusion rate, and incidence of in-hospital mortality and complications were recorded.
Results:
The maximal decrease in hemoglobin levels was lower in the weight-based TXA group than in both the no-TXA and fixed-dose TXA groups (27.8 versus 41.9 g/L, P < 0.001, and 27.8 versus 39.0 g/L, P < 0.001, respectively). However, it did not differ between the no-TXA and fixed-dose TXA groups. Both the fixed-dose and weight-based TXA groups had lower perioperative transfusion rates than the no-TXA group (P < 0.001). In addition, the perioperative transfusion rate was lower in the fixed-dose TXA group than in the weight-based TXA group (P < 0.001). Changes in the dose of intravenous TXA did not significantly impact mortality or major complications in the three groups.
Conclusions:
Compared with fixed-dose TXA, a weight-based TXA dose was associated with less postoperative blood loss in rTHA without increasing the incidence of in-hospital mortality or major complications. Surgeons should consider implementing the weight-based TXA regimen in rTHA to effectively mitigate postoperative blood loss.
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