The use of tranexamic acid to reduce blood loss in uncemented total hip arthroplasty for avascular necrosis of femoral head: a prospective blinded randomized controlled study

Javahir A Pachore,Vikram Indrajit Shah,Kalpesh Shah,Amish Kshatriya,Ashish Sheth,Sachin Upadhyay

doi:10.1186/s42836-019-0012-6

Javahir A Pachore, Vikram Indrajit Shah + Show 4 more

Open Access

https://doi.org/10.1186/s42836-019-0012-6

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Abstract

BackgroundThe purpose of this prospective, double-blinded, randomized controlled study is to assess the efficacy of administration of intravenous tranexamic acid (TXA) for reducing blood loss in uncemented total hip arthroplasty (THA) for the treatment of osteonecrosis of femoral head.MethodsBetween April 2012 and March 2014, 73 patients with avascular necrosis of femoral head were treated in our center. The patients were randomized and allocated to study group (n = 36; treated with TXA) and control group (n = 37). Intra- and postoperative blood loss, blood transfusion, and incidence of deep vein thrombosis were assessed. A p value less than 0.05 was considered statistically significant.ResultsThe intraoperative, postoperative, and total (clinical method and Gross’ formula) blood loss were significantly greater in the control group (p < 0.05). On the first, second, and third postoperative days, the levels of hemoglobin and hematocrit were significantly better in the study group (p < 0.05). There was a significantly greater number of patients who required blood transfusion in the control group (p = .027). Deep vein thrombosis was not found in either group.ConclusionsA single dose of TXA used preoperatively may minimize intraoperative, postoperative, and total blood loss in uncemented THA for the treatment of osteonecrosis of femoral head, and may not increase the risk of prothrombotic complications.

Highlights

The purpose of this prospective, double-blinded, randomized controlled study is to assess the efficacy of administration of intravenous tranexamic acid (TXA) for reducing blood loss in uncemented total hip arthroplasty (THA) for the treatment of osteonecrosis of femoral head
Most randomized controlled trials evaluating the efficacy of tranexamic acid during THA included cohorts with a diagnosis of osteoarthritis or those with either osteoarthritis or osteonecrosis of femoral head [4, 10,11,12,13,14,15,16,17]
We found no randomized controlled trial evaluating the efficacy of intravenous tranexamic acid in reducing perioperative blood loss and need for blood transfusions after uncemented THA for a specific diagnosis of osteonecrosis of the femoral head only and this was the aim of our study

Summary

Introduction

The purpose of this prospective, double-blinded, randomized controlled study is to assess the efficacy of administration of intravenous tranexamic acid (TXA) for reducing blood loss in uncemented total hip arthroplasty (THA) for the treatment of osteonecrosis of femoral head. The use of TXA is a synthetic derivative of lysine that exerts its antifibrinolytic effect by blocking the lysine binding sites of plasminogen, which blocks the degradation of fibrin [8] This process may potentially enhance the risk of venous thromboembolic events (VTEs) by promoting thrombosis [9]. We found no randomized controlled trial evaluating the efficacy of intravenous tranexamic acid in reducing perioperative blood loss and need for blood transfusions after uncemented THA for a specific diagnosis of osteonecrosis of the femoral head only and this was the aim of our study. We hypothesized that a single pre-incisional dose of intravenous tranexamic acid reduces blood loss associated with uncemented THA for osteonecrosis of femoral head

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