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Multicenter Study
. 2019 Sep;85(9):2089-2097.
doi: 10.1111/bcp.14018. Epub 2019 Jul 10.

Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study

Jinwei Xie  1 , Shaoyun Zhang  2 , Guo Chen  1 , Hong Xu  1 , Zongke Zhou  1 , Fuxing Pei  1
Affiliations
Multicenter Study

Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study

Jinwei Xie et al. Br J Clin Pharmacol. 2019 Sep.

Abstract

Aim: This study aimed to compare the efficacy and safety of different tranexamic acid (TXA) routes following primary total hip arthroplasty (THA).

Methods: We collected data from the National Health Database on patients registered from January 2013 to September 2017. The patients were divided based on TXA administration route into a control group (without TXA), intravenous group, topical group and combined group. The primary outcome was transfusion; secondary outcomes were total blood loss, haemoglobin level, decrease in haemoglobin on postoperative day 3, and incidence of complications.

Results: Data were collected on 7667 primary THA, 4662 with TXA and 3005 without TXA. The transfusion rate was 28.7% in the control group, 12.7% in the topical group, 8.9% in the intravenous group, and 6.1% in the combined group, and the inter-group differences were significant (P < .01). The combined group showed significantly smaller total blood loss (1.23 ± 0.52 L), smaller reduction in haemoglobin level (26.5 ± 11.1 g/L) and higher haemoglobin level on postoperative day 3 (107.0 ± 15.5 g/L) than the other three groups (P < .05). The three TXA groups showed significantly lower incidence of deep vein thrombosis than the control group (0.08% vs 0.47%, P = .001) as well as a lower rate of other complications (0.34% vs 0.67%, P = .044).

Conclusion: TXA is effective and safe to decrease blood loss and transfusion following primary THA, regardless of whether it is administered intravenously, topically or both. Intravenous or combined routes may produce better haemostatic effects, so they may be suggested in the absence of contraindications.

Keywords: blood management; deep vein thrombosis; enhanced recovery; total hip arthroplasty; tranexamic acid.

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Conflict of interest statement

There are no competing interests to declare.

Figures

Figure 1
Figure 1
Flow diagram describing the number of patients included
See this image and copyright information in PMC

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