Combined use of intravenous and topical tranexamic acid in patients aged over 70\u2009years old undergoing total hip arthroplasty

Junqing Jia

doi:10.1186/s13018-019-1384-6

Abstract

PurposeThe present study was designed to evaluate the efficacy and safety of combined use of intravenous (IV) TXA administration and topical intraarticular tranexamic acid (TXA) strategy in patients aged over 70 undergoing total hip arthroplasty (THA).MethodsOne hundred eighty patients were randomized into three groups, including an IV group, a local group, and a combined group. Patients were administrated with 15 mg/kg of IV-TXA in the IV group, 2 g TXA in the topical group, or 15 mg/kg IV-TXA combined with 2 g TXA in the combined group. Total blood loss (TBL), maximum hemoglobin drop, the transfusion rate and the number of allogeneic blood units, and the incidence of deep venous thrombosis (DVT), and pulmonary embolism (PE) were recorded and analyzed.ResultsTBL was 757.75 ± 188.95 mL in the combined group, which was significantly lower than in the IV group (892.75 ± 218.47) or the topical group (1015.75 ± 288.71) (p = 0.015, p = 0.001 respectively). The mean values of maximum hemoglobin drop in the combined, IV, and topical groups were 2.67 ± 0.42, 3.28 ± 0.52, and 3.75 ± 0.62 g/dL, respectively, with a significant intergroup difference (p < 0.001 for all). PE was not detected within 1 month after the surgery. Asymptomatic DVT was reported in 1 patient of the IV group, and in 2 patients from the combined group, while the difference was not statistically significant.ConclusionsCompared to intravenous or topical use of TXA, the combined therapy effectively decreased total blood loss and reduced the transfusion rate, simultaneously possessed the same degree of safety in primary THA patients aged over 70.

Highlights

Total hip arthroplasty (THA) has been one of the most satisfying procedures in current orthopedic practice, especially for patients suffering from various painful hip disease, THA can relieve pain and restore the function of the broken hip, and improve patients’ life quality substantially [1].THA is usually associated with substantial blood loss, especially in the first week after surgery, which often results in anemia [2], and the patients suffer a higher risk of cardiopulmonary events and longer recovery period, and higher health care costs [2,3,4]
In total, 201 patients aged over 70 years old primary were performed with THA in our hospital from September 2010 to December 2017
No pulmonary embolism (PE) was detected during the 2-month follow-up, and asymptomatic deep venous thrombosis (DVT) was reported by 1 patient of the IV group, and in 2 patients from the combined group

Summary

Introduction

Total hip arthroplasty (THA) has been one of the most satisfying procedures in current orthopedic practice, especially for patients suffering from various painful hip disease, THA can relieve pain and restore the function of the broken hip, and improve patients’ life quality substantially [1]. THA is usually associated with substantial blood loss, especially in the first week after surgery, which often results in anemia [2], and the patients suffer a higher risk of cardiopulmonary events and longer recovery period, and higher health care costs [2,3,4]. By blocking lysine-binding sites of plasminogen, TXA suppresses fibrinolysis, led to reduced proteolytic activity on the fibrin monomers and fibrinogen and reduced blood loss [7,8,9,10,11].

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