Abstract
Background Total hip arthroplasty (THA) is associated with substantial blood loss in the postoperative course. Tranexamic acid (TXA) is a potent antifibrinolytic agent, routinely administered by intravenous (IV) and topical (intra-articular, IA) route, which can possibly interrupt the cascade of events due to hemostatic irregularities close to the source of bleeding. However, scientific evidence of combined administration of TXA in THA secondary to a femoral neck fracture is still meagre. The present study aims to compare the patients who were administered combined IV and topical TXA with a control group in terms of blood loss, transfusion rate, and incidence of deep vein thrombosis (DVT) and thromboembolism (TE). Patients and Methods. 195 patients with femoral neck fracture underwent THA and were placed into two groups: (1) IV and IA TXA group which had 58 patients and (2) no TXA control group which had 137 patients. In the TXA group, 1 g IV TXA was administered 30 minutes before incision, and 1 g IA TXA was administered intraoperatively after fascia closure. No drains were placed, and soft spica was applied to the hip. Results Combined usage of IV and IA TXA showed better results when compared to the control group in terms of blood transfusion rate (31%) and hemoglobin drop (28%). No cases of DVT or TE were noted among the two study groups. Conclusion Combined use of IV and IA TXA provided significantly better results compared to no TXA use with respect to all variables related to postoperative blood loss in THA. Moreover, TXA use is safe in terms of incidence of symptomatic DVT and TE.
Highlights
Large amounts of perioperative blood loss and large transfusion rates are associated with total joint replacement surgeries
A negative Pearson correlation is present between hemoglobin levels preoperatively and blood transfusions (p < 0.01), and a positive correlation between hemoglobin preoperatively and hemoglobin levels at day 1 and day 5 postoperatively (p < 0.01). is suggests that a higher preoperative hemoglobin reduces the need for transfusions and these patients have higher hemoglobin levels postoperatively
Our findings show no statistically significant difference in terms of preoperative hemoglobin levels and hemoglobin levels at day 5 postoperatively, while statistically significant difference between the two groups was noted in terms of day 1 postoperative hemoglobin levels and total amount of transfusions used intraoperatively and postoperatively
Summary
Large amounts of perioperative blood loss and large transfusion rates are associated with total joint replacement surgeries. Total hip arthroplasty (THA) patients are transfused at rates of 16–37% [1]. Total hip arthroplasty (THA) is associated with substantial blood loss in the postoperative course. E present study aims to compare the patients who were administered combined IV and topical TXA with a control group in terms of blood loss, transfusion rate, and incidence of deep vein thrombosis (DVT) and thromboembolism (TE). Combined usage of IV and IA TXA showed better results when compared to the control group in terms of blood transfusion rate (31%) and hemoglobin drop (28%). Combined use of IV and IA TXA provided significantly better results compared to no TXA use with respect to all variables related to postoperative blood loss in THA. TXA use is safe in terms of incidence of symptomatic DVT and TE
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