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Thromb Res. 2018 Jul;167:1-5. doi: 10.1016/j.thromres.2018.04.026. Epub 2018 May 1.

Oral tranexamic acid is equivalent to topical tranexamic acid without drainage in primary total hip arthroplasty: A double-blind randomized clinical trial.

Author information

1
Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, PR China.
2
Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, PR China.
3
Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, PR China. Electronic address: zongke@126.com.

Abstract

PURPOSE:

To compare the efficacy of multiple doses of oral tranexamic acid (TXA) with topical TXA administration in reducing blood loss following total hip arthroplasty (THA).

PATIENTS AND METHODS:

In this double-blinded trial, 117 patients undergoing primary THA were randomized to receive 2 g TXA orally 2 h preoperatively, and two doses of 1 g TXA postoperatively (oral group) or 3 g of TXA topical administration in the operating room (topical group). The primary outcome was a reduction in hemoglobin concentration. Other outcomes-such as blood loss, TXA-related cost (¥), length of hospital stay (days), complications such as pulmonary thromboembolism (PE), deep vein thrombosis (DVT), and infection, blood coagulation and fibrinolysis, and hip function-were recorded.

RESULTS:

The mean reduction in hemoglobin level was similar between the oral and topical groups (3.07 g/dL compared with 3.12 g/dL; p = 0.85). Similarly, there was no significant difference in the mean total blood loss between oral and topical administration (863 mL compared with 902 mL; p = 0.62). Three patients received an allogeneic blood transfusion, including one patient in the oral group and two patients in the topical group (p = 0.55). The oral group had a significantly lower TXA-related cost than the topical group: ¥944 and ¥4359, respectively (p = 0.01). No PE, DVT, cardiac infarction or renal failure occurred during the 90-day follow-up. The coagulation and fibrinolysis parameters were similar between the two groups.

CONCLUSION:

Oral TXA is equivalent to topical TXA administration in the reduction of blood loss in the setting of primary THA without drainage.

KEYWORDS:

Blood loss; Oral; Topical; Total hip arthroplasty; Tranexamic acid; Transfusion

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