Skip to main content
SpringerLink
Log in

Better Treatment Values in Local Application of Tranexamic Acid (TXA) than Intravenous Application with the Same Dose in Total Hip Arthroplasty

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

The aim of our study was to investigate the hemostatic effect of local and intravenously administered tranexamic acid (TXA) at the same dose in total hip arthroplasty.

Methods

The prospective study included 72 patients who underwent total hip arthroplasty in our hospital between March 2018 and March 2019. The patients enrolled in the study were randomly divided into two groups: the observation group (36 patients were injected with 2.0 g TXA in 10 mL 0.9% NaCl using the joint cavity drainage tube after suturing the joint capsule) and the control group (36 patients were given an intravenous infusion of 2 g TXA in 200 mL 0.9% NaCl 30 min before the operation). In each patient, apparent blood loss, hidden blood loss, average blood transfusion, and the number of cases receiving blood transfusion were compared between the two groups after treatment. Hematocrit (Hct) and hemoglobin (Hb) levels were recorded at postoperative day (POD) 1, 2, 3, 7, and 10. We also recorded the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) before the operation and 12 h postoperative and POD 1, 3, 7, and 10. The incidence of deep venous thrombosis and pulmonary embolism was also taken into account.

Results

In the observation group, apparent blood loss, hidden blood loss, average blood transfusion volume, and the number of patients receiving blood transfusion were lower compared than the control group (P < 0.001). The levels of Hct and Hb were compared between the two groups at POD 1, 2, 3, 7, and 10, and the observation group reported higher levels of Hct and Hb (P < 0.001). The levels of CRP and IL-6 were compared between the two groups at POD 1, 3, 7, and 10, and the observation group reported lower levels of CRP and IL-6 than the control group (P < 0.001). On POD 7, there was no pulmonary embolism in both groups, and no significant difference was observed in the incidence of deep venous thrombosis between the two groups (P > 0.05).

Conclusions

Local and intravenous applications of TXA at the same dose are effective approaches in terms of reducing bleeding and inflammatory reaction with a good safety profile; however, the effect of local application had superior therapeutic values.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ouyang X, Ding Y, Yu L, et al. Effects of hip replacement combined with alendronate sodium on postoperative healing of osteoporotic femoral neck fracture and levels of CTX-1 and BALP in patients. Exp Ther Med. 2019;18(6):4583–90. https://doi.org/10.3892/etm.2019.8158.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Katchy AU, Njeze NR, Ezeofor S, Nnamani K. Geometrical analysis of the proximal femur and the clinical application in total hip replacement: a study of the Igbo population of South East Nigeria. Niger J Clin Pract. 2019;22(12):1728–36. https://doi.org/10.4103/njcp.njcp_634_18.

    Article  CAS  PubMed  Google Scholar 

  3. Bos S, Bernal W, Porte RJ, Lisman T. Hemostatic complications in hepatobiliary surgery. Semin Thromb Hemost. 2017;43(7):732–41. https://doi.org/10.1055/s-0037-1603447.

    Article  PubMed  Google Scholar 

  4. Xu Y, Sun S, Feng Q, et al. The efficiency and safety of oral tranexamic acid in total hip arthroplasty: a meta-analysis. Medicine (Baltimore). 2019;98(46):e17796. https://doi.org/10.1097/md.0000000000017796.

    Article  CAS  Google Scholar 

  5. Jules-Elysee KM, Tseng A, Sculco TP, et al. Comparison of topical and intravenous tranexamic acid for total knee replacement: a randomized double-blinded controlled study of effects on tranexamic acid levels and thrombogenic and inflammatory marker levels. J Bone Jt Surg Am. 2019;101(23):2120–8. https://doi.org/10.2106/jbjs.19.00258.

    Article  Google Scholar 

  6. Kawaguchi K, Kinoshita S, Ishikawa M, Sakura H. Tranexamic acid-induced fixed drug eruption confirmed by the drug lymphocyte transformation test. Clin Case Rep. 2019;7(11):2074–5. https://doi.org/10.1002/ccr3.2442.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pan DQ, Chen LL, Sun B, Yu Z, Ge JB, Miao MF. Effect of tranexamic acid combined flexion position of hip and knee on perioperative bleeding following unilateral total knee arthroplasty. Zhongguo Gu Shang. 2019;32(8):759–64. https://doi.org/10.3969/j.issn.1003-0034.2019.08.017.

    Article  PubMed  Google Scholar 

  8. Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion. 2005;45(8):1302–7. https://doi.org/10.1111/j.1537-2995.2005.00204.x.

    Article  CAS  PubMed  Google Scholar 

  9. Ralley FE, Berta D, Binns V, Howard J, Naudie DD. One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res. 2010;468(7):1905–11. https://doi.org/10.1007/s11999-009-1217-8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Niskanen RO, Korkala OL. Tranexamic acid reduces blood loss in cemented hip arthroplasty: a randomized, double-blind study of 39 patients with osteoarthritis. Acta Orthop. 2005;76(6):829–32. https://doi.org/10.1080/17453670510045444.

    Article  PubMed  Google Scholar 

  11. Imai N, Dohmae Y, Suda K, Miyasaka D, Ito T, Endo N. Tranexamic acid for reduction of blood loss during total hip arthroplasty. J Arthroplasty. 2012;27(10):1838–43. https://doi.org/10.1016/j.arth.2012.04.024.

    Article  PubMed  Google Scholar 

  12. Miao B, Bi X, Ren K, Yu J. Efficacy and safety of tranexamic acid on perioperative blood loss in total knee arthroplasty. Chin J Orthop. 2009;29(9):864–7. https://doi.org/10.3760/cma.j.issn.0253-2352.2009.09.013.

    Article  Google Scholar 

  13. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90(5):596–9. https://doi.org/10.1093/bja/aeg111.

    Article  CAS  PubMed  Google Scholar 

  14. Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Jt Surg Am. 2012;94(13):1153–9. https://doi.org/10.2106/jbjs.K.00873.

    Article  Google Scholar 

  15. Machin JT, Batta V, Soler JA, Sivagaganam K, Kalairajah Y. Comparison of intra-operative regimes of tranexamic acid administration in primary total hip replacement. Acta Orthop Belg. 2014;80(2):228–33.

    PubMed  Google Scholar 

  16. Bao N, Zhou L, Cong Y, et al. Free fatty acids are responsible for the hidden blood loss in total hip and knee arthroplasty. Med Hypotheses. 2013;81(1):104–7. https://doi.org/10.1016/j.mehy.2013.03.038.

    Article  CAS  PubMed  Google Scholar 

  17. Seo JG, Moon YW, Park SH, Kim SM, Ko KR. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1869–74. https://doi.org/10.1007/s00167-012-2079-2.

    Article  PubMed  Google Scholar 

  18. Alshryda S, Mason J, Vaghela M, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). J Bone Jt Surg Am. 2013;95(21):1961–8. https://doi.org/10.2106/jbjs.L.00907.

    Article  Google Scholar 

  19. Sugita J, Fujiu K. Systemic inflammatory stress response during cardiac surgery. Int Heart J. 2018;59(3):457–9. https://doi.org/10.1536/ihj.18-210.

    Article  PubMed  Google Scholar 

  20. Wang D, Luo ZY, Yu ZP, et al. The antifibrinolytic and anti-inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial. J Thromb Haemost. 2018;16(12):2442–533. https://doi.org/10.1111/jth.14316.

    Article  CAS  PubMed  Google Scholar 

  21. Zeng WN, Liu JL, Wang FY, Chen C, Zhou Q, Yang L. Low-dose epinephrine plus tranexamic acid reduces early postoperative blood loss and inflammatory response: a randomized controlled trial. J Bone Jt Surg. 2018;100(4):295–304. https://doi.org/10.2106/JBJS.16.01585.

    Article  Google Scholar 

  22. Jiménez JJ, Iribarren JL, Brouard M, et al. Safety and effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dose-dependent, phase IV clinical trial. J Cardiothorac Surg. 2011;6:138–138. https://doi.org/10.1186/1749-8090-6-138.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Liu P, Liu J, Chen L, Xia K, Wu X. Intermittent pneumatic compression devices combined with anticoagulants for prevention of symptomatic deep vein thrombosis after total knee arthroplasty: a pilot study. Ther Clin Risk Manag. 2017;13:179–83. https://doi.org/10.2147/TCRM.S129077.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Lei YT, Xie JW, Huang Q, Huang W, Pei FX. The antifibrinolytic and anti-inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial. Int Orthop. 2020;44(3):477–86. https://doi.org/10.1007/s00264-019-04469-w.

    Article  PubMed  Google Scholar 

  25. Dowd NP, Karski JM, Cheng DC, et al. Pharmacokinetics of tranexamic acid during cardiopulmonary bypass. Anesthesiology. 2002;97(2):390–9. https://doi.org/10.1097/00000542-200208000-00016.

    Article  CAS  PubMed  Google Scholar 

  26. Jansen JA, Lameijer JRC, Snoeker BAM. Combined intravenous, topical and oral tranexamic acid administration in total knee replacement: evaluation of safety in patients with previous thromboembolism and effect on hemoglobin level and transfusion rate. Knee. 2017;24(5):1206–12. https://doi.org/10.1016/j.knee.2017.07.004.

    Article  PubMed  Google Scholar 

  27. Tengberg PT, Foss NB, Palm H, Kallemose T, Troelsen A. Tranexamic acid reduces blood loss in patients with extracapsular fractures of the hip: results of a randomised controlled trial. Bone Jt J. 2016;98(6):747–53. https://doi.org/10.1302/0301-620x.98b6.36645.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the participants of the study.

Funding

No funding was received for this study. The journal’s rapid service fee was funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

XZ and JP contributed to the conception and design of the study; DM and LW performed the experiments, LW collected and analyzed data; XZ and JP wrote the manuscript; All authors reviewed and approved the final version of the manuscript.

Disclosures

Xiaodong Zhang, Desi Ma, Liang Wen and Jiang Pan have nothing to disclose.

Compliance with Ethics Guidelines

This study was approved by the ethics committee of Beijing Chao-Yang Hospital, and informed consent forms were signed by patients. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments.

Data Availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

    Xiaodong Zhang, Desi Ma, Liang Wen & Jiang Pan

Authors
  1. Xiaodong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Desi Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liang Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiang Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jiang Pan.

Additional information

Digital Features

To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12661730.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, X., Ma, D., Wen, L. et al. Better Treatment Values in Local Application of Tranexamic Acid (TXA) than Intravenous Application with the Same Dose in Total Hip Arthroplasty. Adv Ther 37, 4346–4355 (2020). https://doi.org/10.1007/s12325-020-01454-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-020-01454-3

Keywords

Search

Navigation