The Effect of Tranexamic Acid on Reducing Blood Loss in Cementless Total Hip Arthroplasty Under Epidural Anesthesia

Abstract

Total hip arthroplasty (THA) is associated with high intraoperative and postoperative blood loss. Antifibrinolytic drugs have been used to minimize the potential risks of bleeding and blood transfusion. Studies on the effect of tranexamic acid on decreasing blood loss in THA have revealed interesting results, but most have focused on cemented THA. Yet its benefits in THA, especially in cementless THA, have not been proved. We conducted a prospective double-blind randomized controlled study on 64 patients who were candidates for cementless THA under epidural anesthesia between 2006 and 2008. Patients were randomly assigned into study and control groups. Patients in both groups were well matched regarding preoperative characteristics. Five minutes preoperatively 32 patients of the study and control groups received 15 mg/kg tranexamic acid or normal saline intravenously respectively. Our findings showed a significantly smaller decrease in 6- and 24-hour postoperative hemoglobin levels, less intraoperative and postoperative bleeding, and less need for allogenic blood transfusion in the tranexamic acid group. Our results also revealed a higher mean of 6- and 24-hour hematocrit level and shorter hospital stay in the tranexamic acid group compared to the control group, which were not statistically meaningful. In our study no thromboembolic event was seen; except 1 patient in the control group. Our study showed that administering tranexamic acid before the start of cementless THA under epidural anesthesia can reduce intraoperative and postoperative bleeding as well as need for blood transfusion.

Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis

“…Out of the 33 studies, one was triple-blind [24], 24 were double-blind [2,4-6,8,11,12,14,17,18], [20,25-37], three were single-blind [19,38,39], and in five studies the blinding was unclear [3,40-44]. Additionally, 21 studies had a Jadad score greater than three [2,4-6,11,12,14,17-19,24-27,31], [33-38] indicating they were of high quality.…”

“…Tranexamic acid (TXA) is a synthetic amino acid [2-4,6,9,12,14-16] which competitively blocks the lysine binding sites on plasminogen and thereby slows the conversion of plasminogen to plasmin [2,3,5-8,10,12,14-20]. TXA may be administered intra-venous (IV) or topically in the surgical wound.…”

Can anaesthetic technique effect postoperative outcome?

“…Not only does cell salvage reduce allogeneic transfusion requirements, it may also increase survival after oesophagectomy when compared with allogeneic blood transfusion [59]. The use of antifibrinolytic agents has been shown to reduce blood loss during cardiac, urologic and orthopaedic procedures [60].…”

Effect of Intra-articular Injection of Tranexamic Acid on Postoperative Hemoglobin in Total Hip Arthroplasty

“…A large number of studies 4,7,9,10,12,16,26 discuss the cost-effectiveness of different intravenous tranexamic acid protocols; however, intra-articular use limits the dose required, and thus the cost, making its use more significant. This is because only a small portion of the drug reaches the target location when injected intravenously; therefore, intra-articular administration would provide a more efficient method of delivery.…”

“…3 Several studies have shown the effectiveness of intravenous tranexamic acid use on reducing blood loss in THA. [4][5][6][7][8][9][10][11][12][13][14][15] However, concerns about the safety of the systemic administration of tranexamic acid and the risk of thromboembolic events, such as deep vein thrombosis or pulmonary embolism, in the high-risk THA patient population have hindered the wide adoption of this medication in the setting of total joint arthroplasty. In view of such safety concerns, intraarticular injection of tranexamic acid during THA may be a safer route of administration that will reduce postoperative bleeding while not increasing the hypercoagulable state associated with THA.…”