Clinical curative effect of tranexamic acid on perioperative blood loss in primary total hip arthroplasty among patients with ankylosis spondylitis

Abstract

Objective To explore the validity and safety of application of tranexamic acid(TAX) on amount of blood loss during operative period in patients with ankylosing spondylitis who were underwent primary unilateral total hip arthroplasty. Methods The prospective study was conducted. The clinical data of 50 cases of ankylosing spondylitis who underwent unilateral primary total hip replacement at the Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University from May 2015 to August 2017 were selected. A total of 50 patients were enrolled and randomized into the study group (n=25) and control group (n=25) random number table . The patients in the study group were given 15 mg/kg TXA dissolved in 250 ml normal saline by intravenous administration at 10 minutes before incision, and intra-articular injection after close the joint capsule. The patients in the control group were given with 250 ml 0.9% saline by intravenous and 10 ml 0.9% saline by hip joint capsule injection at the the same dose instead. The amount of overt blood loss, hidden blood loss, haemoglobim level, hematocrit, the volume of blood transfusion, and number of blood transfusion were compared between two groups. The Color Doppler flow imaging of the lower limbs was performed to detect deep venous thrombosis and pulmonary embolism. Measurement data were expressed as mean±standard deviation (±s). It was expressed by t test. Count data were expressed as percentage (%). The data were statistically analysized by χ2 test between two groups. Results The amount of overt blood loss, hidden blood loss, haemoglobin level, hematocrit, blood transfusion volume and blood transfusion in the study group were (538.9±103.6) ml, (93.2±30.6) ml, (103.4±10.2) g/L, (0.31±0.04)/L, (210.4±45.7) ml, 4 cases. The indexes in the control group were (831.5±120.8) ml, (175.8±42.3) ml, (95.7±10.1) g/L, (0.26±0.03)/L, (439.8±78.1) ml, and 12 cases, respectively. In patients of study group, the amount of intraoperative blood loss, volume of postoperative drainage, amount of visible blood loss, hidden blood loss and the volume of blood transfusion were less than those of patients in control group, and the difference was statistically significant (P<0.05). Calf muscular venous thrombosis was found in one case of observation group. No pulmonary embolism occurred in both groups. Conclusion The application of TAX can significantly decrease the amount of blood loss during operative period in patients with ankylosing spondylitis who were underwent primary unilateral total hip arthroplasty without increasing risk for deep venous thrombosis. Key words: Tranexamic acid; Arthroplasty, replacement, hip; Spondylitis, ankylosing; Postoperative hemorrhage; Venous thrombosis