Evaluation of efficacy and safety of systemic and topical intra-articular administration of tranexamic acid in primary unilateral total hip arthroplasty

• Published in: Medicine (Baltimore) Vol. 100; no. 26; p. e26565
• Main Authors: Juraj, Masaryk, Jaroslav, Vidan, Gažová, Andrea, Žufková, Viera, Kyselovič, Ján, Šteňo, Boris
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 02.07.2021
• Subjects: Administration, Intravenous - methods; Aged; Antifibrinolytic Agents - administration & dosage; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Blood Transfusion - statistics & numerical data; Clinical Trial/Experimental Study; Drug Monitoring; Female; Hemoglobins - analysis; Humans; Injections, Intra-Articular - methods; Male; Postoperative Hemorrhage - blood; Postoperative Hemorrhage - prevention & control; Risk Adjustment - methods; Slovakia; Tranexamic Acid - administration & dosage; Tranexamic Acid - adverse effects; Treatment Outcome; Slovakia
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000026565

Tranexamic acid (TXA) is an antifibrinolytic agent used to reduce bleeding in major surgical procedures. This study evaluates the efficacy and safety of the systemic and topical intra-articular administration of TXA in total hip arthroplasty (THA). Patients (N = 123) scheduled for primary unilateral THA were divided into 3 treatment groups: control group; TXA, systemic, repeated 1 g bolus; TXA, topically intra-articularly, 2 g in 50 mL saline. Primary readouts used were intra- and postoperative bleeding, transfusion requirement, postoperative hemoglobin levels and complications. Both systemic and topical intra-articular TXA administrations decreased bleeding and transfusion requirements. Topical intra-articular use of TXA led to the reduction in intraoperative and postoperative bleeding and affected hemoglobin levels compared with control. Systemic administration of TXA led to a significant reduction of postoperative bleeding and transfusion rate compared with control and was not different in efficacy and complication incidence when compared to topical administration of TXA. The use of TXA to reduce blood loss and transfusion requirements in THA is an effective and safe concept in practice. The dose of 2 g TXA topically intra-articularly and a repeated bolus of 1 g TXA systematic led to lower intra- and postoperative bleeding and a significantly lower transfusion rate than the control group. Topical intra-articular TXA administration could be a reasonable alternative in high-risk patients.