Blood conservation with tranexamic acid in total hip arthroplasty: A randomized, double-blind study in 40 primary operations

Abstract

We studied the effect of tranexamic acid (TA), given intravenously at the beginning of the operation, on blood loss as well as on need for blood transfusions in primary total hip arthroplasty.

Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement

“…From the present study and the available literature on TA in TKR and THR, the administration of TA does not seem to increase the risks of inducing thromboembolic phenomenons (total incidence of 15/305 (4.3%) with TA vs 22/345 (7.2%) with placebo). [10][11][12][13][14][15][16][17][18][19] In the present study, despite a 56.2% relative risk reduction in the number of transfused patients; there was no difference in measured blood losses. In order not to increase the risks of prosthesis infection of patients undergoing THR and TKR, surgical drains are now either rapidly removed or even avoided.…”

“…There was a 24% decrease in measured blood losses (P = 0.01) but the decrease in the total number of units transfused (5 vs 13) was not statistically significant. 19 In the third study, patients were randomized to receive placebo or two iv doses of TA 10 mg·kg -1 (first dose just before the surgery) plus an infusion of 1 mg·kg -1 ·hr -1 until skin closure. 18 The authors reported a 36% decrease in measured blood losses.…”

“…[17][18][19] In the first study, patients were randomized to receive placebo or two iv doses of TA 10 mg·kg -1 after surgery. 17 The investigators found a 62% relative risk reduction in the number of patients who required a red blood cell transfusion with TA (4/19) compared to placebo (11/20), but no difference in measured blood losses.…”

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

“…The rationale for AKI = acute kidney injury; DVT = deep vein thrombosis; Hb = hemoglobin concentration; MI = myocardial infarction; PE = pulmonary embolism; RBC = red blood cells; THA = total hip arthroplasty; TKA = total knee arthroplasty; TXA = tranexamic acid utilizing the TXA dose was established independently in 2012 prior to initiation of the protocol following an extensive review of available literature by the Pharmacy and Therapeutics Committee. [2][3][4][5][6][9][10][11][14][15][16][17] It was determined that, from the highly variable dosing reported, this 20 mgÁkg -1 dose provided a balance between reducing perioperative blood loss and RBC transfusion while limiting the incidence of potential adverse events. Nevertheless, this study did not incorporate a well-defined a priori standardized intraoperative fluid management strategy with strictly defined transfusion triggers, which limited the interpretation of our data.…”

Blood Transfusion in Knee Arthroplasty

“…Optimal technique would be with two tranexamic acid bolus (each of them 10-15 mg/Kg), one before surgery and another when letting the air out of the tourniquet. In total hip prosthesis, tranexamic acid results in a decrease of intraoperative bleeding when administered prophylactically (Benoni et al, 2001), with no raise in thromboembolic complications incidence (Johansson et al, 2005b). However, it must only be used in those patients of whom a significant blood loss is expected.…”