The use of tranexamic acid to reduce blood loss in primary cementless total hip arthroplasty

Tranexamic acid is an inhibitor of fibrinolysis and thereby decreases blood loss in patients undergoing surgery.

Fifty patients were randomized to Tranexamic acid (15 mg/kg) given as a bolus intravenous injection or placebo (normal saline) given intravenously, 15 min before the incision. The intraoperative and postoperative blood loss and the number of blood transfusions required were recorded. The patients were screened for deep venous thrombosis with bilateral compression ultrasonography on the 10th postoperative day. The hemoglobin level was measured preoperatively and on the 3rd postoperative day. The D-dimer levels were measured preoperatively and 24-h postoperatively.

Patients receiving Tranexamic acid had a mean intraoperative blood loss of 410 ml (range, 300–510 ml) vs. 615 ml (range, 515–750 ml) (P value < 0.05) in patients receiving placebo, a postoperative blood loss of 210 ml (range, 150–325 ml) vs. 490 ml (range, 370–540 ml) (P value < 0.05), and a total need for 8 blood transfusions versus 30. 6/25 patients in first group and 18/25 patients in the placebo group required transfusion. In placebo group, the mean fall in hemoglobin was 2.9 g/dl (range, 2.5–3.2) when compared to 1.6 g/dl (1.3–2) (P < 0.05) in the Tranexamic group. At 24-h postoperatively, mean plasma D-dimer concentration in the Tranexamic group was half of that in the control group. No patient in either group had any evidence of deep vein thrombosis.

Tranexamic acid given as a single preoperative bolus dose reduces intraoperative and postoperative and total blood loss and transfusion requirements in primary cementless total hip replacement surgery without any increased risk of thrombus formation.