Topical, intravenous tranexamic acid and their combined use are equivalent in reducing blood loss after primary total hip arthroplasty

Abstract

ObjectiveTo determine the equivalence of tranexamic administration topically, intravenously or the combination of both routes are equivalent in reducing blood loss after primary total hip arthroplasty. Material and methodsIn this prospective study, we divided 285 THA into four groups. Group A received 2,5 g of intraarticular topical TXA, Group B did not receive TXA, Group C received 1 g intravenous TXA and group D a combination of topical and intravenous TXA. The main outcome was blood loss according to Nadler's formula and total hemoglobin. ResultsBlood loss was significantly greater in Group B (Group A. 797,13 mL; Group B: 1308,24; Group C: 986,30 and Group D: 859,09 mL; P < ,01) with no differences between the other groups. Hemoglobin loss was greater in Group B (11.81, 19.46, 14.52 and 12.78 respectively, P < .001). Two patients (3,1%) were transfused in Group A, 4 (5,3%) in Group B, 3 (3,4%) in Group C, and 1 (1,8%) in Group D (P = ,75). The mean reduction in hemoglobin at 48 h was less in the topical Group (P < ,05). In comparison with Group B the mean reduction in hemoglobin after 48 h was greater (P < ,001) and we can also see a longer hospital stay (P < ,001). One patient in Group A presented pulmonary thromboembolism 72 h after surgery, which was resolved without complications. ConclusionsThe administration of tranexamic acid topically, intravenously or in combination in primary total hip arthroplasty, is a simple and safe procedure that provides equivalent reductions in hemoglobin and blood loss.