Effect of Intra-articular Injection of Tranexamic Acid on Postoperative Hemoglobin in Total Hip Arthroplasty

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.

Additional intraarticular tranexamic acid further reduced postoperative blood loss compared to intravenous and topical bathed tranexamic acid in total hip arthroplasty: a retrospective sequential series study

“…The potential advantages of topical application of TXA were direct targeting of the site of bleeding and prevention of systemic adverse effects . Several studies reported that topical use of TXA (10 mg/kg; 3 g) was also effective in reducing postoperative blood loss in THA . The second phase showed that postoperative blood loss was significantly lower in the TITA group than that of the IVTA‐II group.…”

“…Recently, the growing perioperative use of tranexamic acid (TXA) demonstrated its efficacy in reducing blood loss and postoperative transfusions after THA . Several investigators sought to elicit the clinical outcomes of TXA in total joint arthroplasty, and the majority of their studies utilized intravenous (IV) administration of TXA, many of which involved the administration of multiple doses .…”

The efficacy of topical tranexamic acid in total hip arthroplasty: a meta-analysis

“…However, there are still controversy about the efficacy of TXA in THA. Some studies reported better outcomes in TXA for reducing blood loss [ 14 – 23 ] while other studies found no differences for transfusion rates [ 24 – 27 ] between the two groups.…”

Uso del ácido tranexámico tópico en la artroplastia total de cadera como medida de ahorro de sangre: aplicación en el servicio de traumatología del Hospital Río Hortega de Valladolid

“…Proponen que utilizando el fármaco de forma local podría aumentarse su concentración en la región de interés, mejorando por tanto su efectividad y disminuyendo además los efectos secundarios (que estarían producidos mayoritariamente por el reparto sistémico del TXA). Muchos autores posteriormente han corroborado la eficacia y seguridad de esta vía, tanto en las prótesis de cadera como en las prótesis de rodilla (88,180,186,(194)(195)(196)(197)(198)(199).…”

“…La variable principal a estudio fue la tasa de transfusión o porcentaje de pacientes transfundidos dentro del grupo TXA y dentro del grupo control. proporción la más habitual en la literatura (88,166,167,169,184,197,203).…”