The use of tranexamic acid in patients submitted to primary total hip arthroplasty: an evaluation of its impact in different administration protocols

Abstract

ObjectivesThere is still no consensus as to the best form and dosages of use of tranexamic acid. The aim of this study was to evaluate the use of tranexamic acid in total hip arthroplasty, in order to reduce blood loss and decrease hemoglobin, taking into account different administration protocols.Methods42 patients submitted to total hip arthroplasty were divided into three groups. The study was prospective and randomized. Group 1 received a venous dose of tranexamic acid of 15 mg/kg, 20 min prior to bolus incision. Group 2 received an intravenous dose of 15 mg/kg bolus, 20 min before the incision, and an extra dose of 10 mg/kg by infusion pump during the duration of the surgical procedure. Patients in group 3 did not receive tranexamic acid, being the control group. Pre- and post-operative hemoglobin levels were measured and blood loss was measured 24 h after surgery using a Portovac drain.ResultsThere was a significant reduction in the amount of bleeding through the Portovac drain and reduction in postoperative hemoglobin drop in patients who used tranexamic acid. There was neither significant difference in hemoglobin drop between groups 1 and 2, nor was there a need for hemotransfusion. Two patients in group 3 required blood transfusion.ConclusionsThe findings demonstrated that the use of intravenous tranexamic acid in total hip arthroplasty reduced postoperative bleeding rates and significantly reduced serum hemoglobin without increasing thromboembolic effects. The bolus and bolus + infusion pump methods were shown to have a similar influence on hemoglobin and need for blood transfusion.

Fraturas intracapsulares do colo femoral no idoso

“…As for the different administration protocols, the use of the bolus and bolus/infusion pump methods has shown to have a very similar influence on serum hemoglobin and the amount of blood loss through the suction drains, showing no statistically significant differences. 15…”

“…As for the different administration protocols, the use of the bolus and bolus/infusion pump methods has shown to have a very similar influence on serum hemoglobin and the amount of blood loss through the suction drains, showing no statistically significant differences. 15 A Cochrane review showed that, in an emergency surgical setting, TXA reduced the likelihood of receiving an erythrocyte transfusion by 30%. 14…”

“…Quanto aos diferentes protocolos de administração, o uso dos métodos bolus e bolus/ bomba de infusão demonstraram ter uma influência bastante semelhante quanto à hemoglobina sérica e à quanti-dade de perda sanguínea através dos drenos de sucção, não demonstrando diferenças com relevância estatística. 15…”

The role of tranexamic acid in decreasing intraoperative and postoperative blood loss in patients undergoing total hip replacement

“…Total hip arthroplasty (THA) has become an excellent treatment method for pain relief and functional improvement in patients with degenerative hip joint disease. Osteoarthritis (OA) is one of the most common chronic conditions, particularly in elderly populations, which leads to pain and loss of function [1,2] . Total hip arthroplasty (THA) is a surgical intervention that is carried out in end-stage arthritis patients.…”

Two Doses of Intravenous Tranexamic Acid Offers No Benefit over One Dose in Total Hip Arthroplasty

“…They included only randomized studies and reported that the use of multiple dose regimens produced a profound risk reduction in need for transfusion. Melo et al 22 divided 42 patients into three dosing groups as follows: (1) noTXA, (2) one 15 mg/kg IV bolus 20 minutes before incision, and (3) the same bolus dose as group two with the addition of a 10 mg/kg by infusion pump for the duration of the procedure. They observed the TXA groups to be superior to the control group in terms of hemoglobin drop and need for transfusion, with no difference between the TXA dosing regimens.…”