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Orthopedics, 2014;37(6):e557–e562
Published Online:https://doi.org/10.3928/01477447-20140528-56Cited by:7

Abstract

Postoperative anemia is a significant risk factor in total hip arthroplasty, leading to increased length of hospital stay and delayed mobility and rehabilitation, and is poorly tolerated by patients with peripheral vascular and cardiovascular disease. Intravenous tranexamic acid, an antifibrinolytic drug, has been shown to reduce postoperative anemia in total joint replacement. Intra-articular administration eliminates the risk of systemic effects, the most concerning of which is thrombosis. Although this method of administering tranexamic acid has been studied in total knee replacement, currently no literature has been published on its efficacy in primary total hip replacement. The purpose of this study was to examine postoperative hemoglobin decrease and the transfusion rate following intra-articular tranexamic acid administration in primary total hip arthroplasty. The authors conducted a retrospective review of 181 consecutive total hip replacements, 91 of which received tranexamic acid. No statistical significance was found between these groups in any of the demographic variables. Postoperative hemoglobin decrease in the control group was 4.4±1.0 g/dL compared with a decrease of 3.6±1.1 g/dL in the tranexamic group, demonstrating an 18% reduction in blood loss (P<.001). No significant difference was found between the number of patients transfused (P=.777) or the number of units used (P=.993). No clotting events were seen in either group. Overall, the study demonstrates that intra-articular tranexamic acid in primary total hip arthroplasty is associated with a significant improvement in postoperative hemoglobin decrease without systemic hypercoagulability.

  • 1.Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999; 81:2–10.

    > Crossref MedlineGoogle Scholar
  • 2.Williamson LM, Lowe S, Love EM, et al.Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ. 1999; 319:16–19.10.1136/bmj.319.7201.16

    > Crossref MedlineGoogle Scholar
  • 3.Astedt B. Clinical pharmacology of tranexamic acid. Scand J Gastroenterol Suppl. 1987; 137:22–25.10.3109/00365528709089756

    > Crossref MedlineGoogle Scholar
  • 4.Ekback G, Axelsson K, Ryttberg L, et al.Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg. 2000; 91:1124–1130.10.1213/00000539-200011000-00014

    > Crossref MedlineGoogle Scholar
  • 5.Yamasaki S, Masuhara K, Fuji T. Tranexamic acid reduces blood loss after cementless total hip arthroplasty: prospective randomized study in 40 cases. Int Orthop. 2004; 28:69–73.10.1007/s00264-003-0511-4

    > Crossref MedlineGoogle Scholar
  • 6.Ralley FE, Berta D, Binns V, Howard J, Naudie DD. One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res. 2010; (486):1905–1911.10.1007/s11999-009-1217-8

    > Crossref MedlineGoogle Scholar
  • 7.Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009; 91:776–783.10.1302/0301-620X.91B6.22393

    > Crossref MedlineGoogle Scholar
  • 8.Hynes MC, Calder P, Rosenfeld P, Scott G. The use of tranexamic acid to reduce blood loss during total hip arthroplasty: an observational study. Ann R Coll Surg Engl. 2005; 87:99–101.10.1308/147870805X28118

    > Crossref MedlineGoogle Scholar
  • 9.Johansson T, Pettersson LG, Lisander B. Tranexamic acid in total hip arthroplasty saved blood and money: a randomized, double-blind study in 100 patients. Acta Orthop. 2005; 76:314–319.

    > Crossref MedlineGoogle Scholar
  • 10.Kazemi SM, Mosaffa F, Eajazi A, et al.The effect of tranexamic acid on reducing blood loss in cementless total hip arthroplasty under epidural anesthesia. Orthopedics. 2010; 33:17.10.3928/01477447-20091124-30

    > LinkGoogle Scholar
  • 11.Singh J, Ballal MS, Mitch P, Denn PG. Effects of tranexamic acid on blood loss during total hip arthroplasty. J Orthop Surg (Hong Kong). 2010; 18:282–286.

    > Crossref MedlineGoogle Scholar
  • 12.Husted H, Blønd L, Sonne-Holm S, Holm G, Jacobsen TW, Gebuhr P. Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty: a prospective randomized double-blind study in 40 patients. Acta Orthop Scand. 2003; 74:665–669.10.1080/00016470310018171

    > Crossref MedlineGoogle Scholar
  • 13.Ekbäck G, Axelsson K, Ryttberg L, et al.Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg. 2000; 91:1124–1130.10.1213/00000539-200011000-00014

    > Crossref MedlineGoogle Scholar
  • 14.Clavé A, Fazilleau F, Dumser D, Lacroix J. Efficacy of tranexamic acid on blood loss after primary cementless total hip replacement with rivaroxaban thromboprophylaxis: a case-control study in 70 patients. Orthop Traumatol Surg Res. 2012; 93:484–490.10.1016/j.otsr.2011.12.005

    > CrossrefGoogle Scholar
  • 15.Claeys MA, Vermeersch N, Haentjens P. Reduction of blood loss with tranexamic acid in primary total hip replacement surgery. Acta Chir Belg. 2007; 107:397–401.

    > Crossref MedlineGoogle Scholar
  • 16.Seo JG, Moon YW, Park SH, Kim SM, Ko KR. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012; 21:1869–1874.10.1007/s00167-012-2079-2

    > Crossref MedlineGoogle Scholar
  • 17.Ishida K, Tsumura N, Kitagawa A, et al.Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011; 35:1639–1645.10.1007/s00264-010-1205-3

    > Crossref MedlineGoogle Scholar
  • 18.Carson JL, Duff A, Berlin JA, et al.Perioperative blood transfusion and postoperative mortality. JAMA. 1998; 279:199–205.10.1001/jama.279.3.199

    > Crossref MedlineGoogle Scholar
  • 19.Lemaire R. Strategies for blood management in orthopedic and trauma surgery. J Bone Joint Surg Br. 2008; 90:1128–1136.10.1302/0301-620X.90B9.21115

    > Crossref MedlineGoogle Scholar
  • 20.Mercuriali F, Inghilleri G. Transfusion risk and limitations. Minerva Anestesiol. 1999; 65:286–292.

    > MedlineGoogle Scholar
  • 21.Madjdpour C, Spahn DR. Allogenic red blood cell transfusions: efficacy, risks, alternative and indications. Br J Anaesth. 2005; 95:33–42.10.1093/bja/aeh290

    > Crossref MedlineGoogle Scholar
  • 22.Orpen NM, Little C, Walker G, Crawfurd EJ. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomized controlled trial of 29 patients. Knee. 2006; 13:106–110.10.1016/j.knee.2005.11.001

    > Crossref MedlineGoogle Scholar
  • 23.Salido JA, Martin LA, Gómez LA, Zorrilla P, Martinex C. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am. 2002; 84:216–220.

    > Crossref MedlineGoogle Scholar
  • 24.Umlas J, Foster RR, Dalal SA, O’Leary SM, Garcia L, Kruskall MS. Red cell loss following orthopedic surgery: the case against postoperative blood salvage. Transfusion. 1994; 34:402–406.10.1046/j.1537-2995.1994.34594249051.x

    > Crossref MedlineGoogle Scholar
  • 25.de Andrade JR, Jove M, Landon G, Frei D, Guilfoyle M, Young DC. Baseline hemoglobin as a predictor of risk of transfusion and response to Epoetin alpha in orthopedic surgery patients. Am J Orthop (Belle Mead NJ). 1996; 25:533–542.

    > MedlineGoogle Scholar
  • 26.Benoni G, Carlsson A, Petersson C, Fredin H. Does tranexamic acid reduce blood loss in knee arthroplasty?Am J Knee Surg. 1995; 8:88–92.

    > MedlineGoogle Scholar
  • 27.Sukeik M, Alshruda S, Haddad FS, Mason JM. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone and Joint Surg Br. 2011; 93:39–46.10.1302/0301-620X.93B1.24984

    > Crossref MedlineGoogle Scholar
  • 28.Reid RW, Zimmerman AA, Laussen PC, Mayer JE, Gorlin JB, Burrows FA. The efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery. Anesth Analg. 1997; 84:990–996.

    > Crossref MedlineGoogle Scholar
  • 29.Sano K, Hakumizu H, Kojima T, Akimoto K. Absorption and excretion of tranexamic acid in human. Clin Pharmacol Ther. 1976; 7:375–382.10.3999/jscpt.7.375

    > CrossrefGoogle Scholar
  • 30.Mannucci PM. Hemostatic drugs. N Engl J Med. 1998; 339:245–253.10.1056/NEJM199807233390407

    > Crossref MedlineGoogle Scholar
  • 31.Graham ID, Alvarex G, Tetroe J, McAuley L, Laupacis A. Factors influencing the adoption of blood alternatives to minimize allogeneic transfusion: the perspective of eight Ontario hospitals. Can J Surg. 2002; 45:132–140.

    > MedlineGoogle Scholar
  • 32.Katsumata S, Nagashima M, Kato K, et al.Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand. 2005; 49:510–516.10.1111/j.1399-6576.2005.00621.x

    > Crossref MedlineGoogle Scholar
  • 33.Johansson T, Lisander B, Ivarsson I. Mild hypothermia does not increase blood loss during total hip arthroplasty. Acta Anaesthesiol Scand. 1999; 43:1005–1010.10.1034/j.1399-6576.1999.431006.x

    > Crossref MedlineGoogle Scholar
  • 34.Thorsson O, Leander P, Lilja B, et al.Comparing ultrasonography, magnetic resonance imaging and scintigraphy in evaluating an experimentally-induced hematoma. Scand J Med Sci Sports. 1993; 3:110–116.10.1111/j.1600-0838.1993.tb00371.x

    > CrossrefGoogle Scholar
  • 35.Jans Ø, Kehlet H, Hussain Z, Johansson PI. Transfusion practice in hip arthroplasty: a nationwide study. Vox Sang. 2011; 100:374–380.10.1111/j.1423-0410.2010.01428.x

    > Crossref MedlineGoogle Scholar

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