Transfusion rate, hospital stay and cost-effectiveness of intravenous or local administration of tranexamic acid in total hip and knee arthroplasty: A single-center randomized controlled clinical study

Abstract

We have conducted a prospective randomized study to determine the effect of intravenous or local administration of tranexamic acid (TXA) in perioperative transfusion rates, hospital stay and overall hospitalization costs in patients underwent total knee (TKA) or total hip (THA) arthroplasty. During 2015- 2016, 125 THA and 124 TKA consecutive patients were randomly allocated to receive low dose TXA either intravenously (ivTXA groups) or local administration (locTXA groups) or to serve as controls. Power analysis showed that 41 patients in each group were required in order to have an 80% probability of demonstrating a between surgeries difference of more than 35%. Full blood counts obtained on the first and third postoperative day and the maximum hemoglobin difference was documented in all patients. The costs of hospitalization, transfusions and TXA were retrieved by the hospital financial administration. All groups were homogenic in regards to age and preoperative Hgb levels. In both THA and TKA patients, a statistically significant reduction in the maximum hemoglobin difference was found for both the intravenous (ivTXA) and local application (locTXA) groups compared to controls (P<0.001). The average hospitalization was reduced by 2.2 and 2.9 days in THA and TKA patients in respect. The hospitalization costs for the control groups were higher both in THA (286 € more) and TKA (374 € more) patients. We were able to demonstrate that both intravenous and local administration of TXA can significantly reduce transfusion rate, hospital stay and overall cost in TKA or THA patients.

Retrospective Comparative Study of the Influence on Quality of Primary Total Hip Arthroplasty by the EndoCert-Certification System in a Communal Hospital

“…The difference between preoperative and postoperative haemoglobin levels could be used as an indication of perioperative blood loss [21]. The results are comparable with other studies which report a postoperative haemoglobin drop of between 21 % to 28.5 % [21,22]. The postoperative haemoglobin check, however, was performed in these trials on the third postoperative day and not, as in the present work, on the second postoperative day.…”

“…Transfusion rates after total prosthetic hip replacement generally demonstrate large ranges of variation of between 4 % to 68 % [23]. Studies without the perioperative administration of tranexamic acid report transfusion rates of between 37 % to 62.8 % [21,22]. Accordingly, the postoperative blood transfusion rate in all three groups is generally low and demonstrates a significantly lower rate under certified standards.…”

Tranexamic acid reduces blood cost in long-segment spinal fusion surgery: Retraction

“…TXA has been proven to reduce perioperative blood loss and transfusion cost in various surgical procedures. [ 18 , 19 ] However, few study has reported the use of TXA in long-segment spinal fusion surgery. Thus, no consensus has been reached on the optimal regimen of the TXA delivery.…”

Role of tranexamic acid to reduce blood loss and transfusion of allogeneic blood in the field of surgery

“…23 Therefore reducing cost as well as hospital stay. 25,26 Despite the higher risk of blood loss and need for transfusion following revision total knee arthroplasty, lowest effective dose and least costly regimen should be used due to similar effect in the management of blood loss with all TXA dosing regimens. 27 Efficacy of TXA in gynecology and obstetrics i).…”