The use of tranexamic acid to reduce blood loss during total hip arthroplasty: an observational study

Abstract

Introduction:To test the hypothesis that the fall in haemoglobin following total hip arthroplasty is reduced by tranexamic acid administration. Patients and Methods: A cohort of 64 patients were studied, 32 received tranexamic acid 20 mg/kg on induction. Surgery was performed by the senior author in a standardised fashion. Haemoglobin levels were measured 2 weeks pre-and 3 days postoperatively. Any complications were noted. The study group was matched using the bone and joint research database for age, sex, procedure, disease and pre-operative haemoglobin level. Results: In the group receiving no tranexamic acid, the mean fall in haemoglobin was 3.8 g/dl (CI of mean 3.4-4.3) and in the group treated with tranexamic acid 2.8 g/dl (CI of mean 2.5-3.2) P < 0.05. Complications included one non-fatal pulmonary embolus in the tranexamic acid group. Conclusions: The administration of 20 mg/kg of tranexamic acid on induction of surgery is an effective method of reducing the haemoglobin fall following hip arthroplasty.

The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial

“…Tranexamic acid inhibits fibrinolysis by blocking the lysine binding sites of plasminogen to fibrin. It has been proposed that therapeutic plasma concentrations of tranexamic acid (5 -10 mg/L) may be achieved with an IV bolus dose of 10 mg/kg followed by an infusion of 1.0 mg/kg/hr during extracorporeal circulation in cardiac surgery [14], and the therapeutic concentration of tranexamic acid is maintained for approximately three hours [15]. Considering the relatively short duration of FESS, we assumed that a single bolus dose of TA 10 mg/kg would fulfill our therapeutic goal.…”

Effects of Tranexamic Acid on Blood Loss during Total Hip Arthroplasty

“…Avoidance of allogenic blood transfusions has economic benefits and minimises the risk of related infections and other adverse reactions, [16][17][18][19] and is associated with reduced morbidity and shorter hospital stays. 18,20,21 The use of TA increases the risk of thromboembolic events (especially deep vein thrombosis). Nonetheless, in our study, such increases were not observed, which is consistent with other findings reported in * Mann-Whitney U test 6,7 The use of TA is not associated with increased thromboembolic events, because the effects of TA are more pronounced in operative wounds than in peripheral venous blood.…”

“…This is because generation of tissue plasminogen activator (activating the fibrinolytic pathway) ensues in wounds. 2,11,21 Thus, TA acts as a clot stabiliser and not a clot promoter.…”

Does salvage and tranexamic acid reduce the need for blood transfusion in revision hip surgery?

“…The use of cell salvage and tranexamic acid alone has been shown to substantially reduce the need for allogenic transfusion. 2,3 Tranexamic acid works as a fibrinolytic inhibitor. This study examines this combination during revision surgery of the hip.…”