Abstract
Objective To investigate the efficacy and safety of tranexamic acid on bleeding in rheumatoid arthritis (RA) patients undergoing total hip arthroplasty (THA). Methods A retrospective study was performed in 197 RA patients (Steinbrocker III-IV) following primary unilateral THA from June 2012 to June 2014. The patients were divided to three groups based on the regimen of tranexamic acid: 68 patients received a single intravenous dosage of 15 mg/kg tranexamic acid 20 min prior to operation (single dose group); 74 patients received an intravenous dosage of 15 mg/kg preoperatively and a second dosage of 10 mg/kg 3 hours postoperatively (repeated dose group); the other 55 patients didn't receive tranexamic acid (control group). The primary outcomes were total blood loss, transfusion rate, the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). The secondary outcomes were postoperative drainage, hemoglobin (Hb) drop on third day postoperatively and other wound related complications. Results There was less total blood loss (816.80±245.09 ml vs 975.15±216.33 ml vs 1 295.68±263.85 ml), drainage (221.60±70.05 ml vs 337.20±113.10 ml vs 479.74±120.66 ml), transfusion requirement (5.41% vs 10.29% vs 25.45%) and Hb drop (2.71±0.74 g/dl vs 3.18±0.62 g/dl vs 3.83±0.70 g/dl) in experimental group when compared with control group. And the effect was better in repeated dose group, with less total blood loss (816.80±245.09 ml), less transfusion requirement (5.41%) and less postoperative drainage (221.60±70.05 ml). No episode of DVT or PE occurred in either group. There were 8 wound complications in single dose group, 6 in repeated group, and 8 in control group, and there were no statistically difference. Conclusion Intravenous administration of tranexamic acid was effective and safe on decreasing blood loss and transfusion requirement in RA patients following THA. Compared with a single dosage of tranexamic acid preoperatively, a second dosage of tranexamic acid 3 hours post-operatively was recommended. Key words: Tranexamic acid; Arthritis, rheumatoid; Arthroplasty, replacement, hip; Blood loss, surgical
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