Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial

J Arthroplasty. 2016 May;31(5):1022-6. doi: 10.1016/j.arth.2015.11.003. Epub 2015 Nov 10.

Abstract

Background: Tranexamic acid (TXA) reduces perioperative blood loss in total hip arthroplasty (THA).

Methods: In our randomized control trial, 139 patients were enrolled and received 2 g of either topical or intravenous (IV) TXA. Preoperative and postoperative protocols were standardized.

Results: Calculated blood and Hgb loss were lower in the IV group (1195.0 ± 485.9 mL, 1442.7 ± 562.7 mL; P = .006), (160.3 [g] ± 63.8, 188.4 [g] ± 68.5; P = .014). There was a trend toward significance in transfusion reduction (11% [IV] vs 18% [topical]; P = .3). Both groups effectively reduced the transfusion rate. There was significant financial incentive for the use of TXA in THA with a savings of $314 per patient.

Conclusions: IV and topical TXA are effective tools to reduce blood loss and transfusion costs in THA, and we recommend the IV form for ease of use.

Keywords: cost reduction in primary hip arthroplasty; perioperative blood conservation; risk reduction in primary hip arthroplasty; total hip arthroplasty; tranexamic acid.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravenous
  • Administration, Topical
  • Aged
  • Antifibrinolytic Agents / administration & dosage*
  • Antifibrinolytic Agents / therapeutic use
  • Arthroplasty, Replacement, Hip*
  • Blood Loss, Surgical / prevention & control*
  • Blood Transfusion
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / prevention & control*
  • Prospective Studies
  • Tranexamic Acid / administration & dosage*
  • Tranexamic Acid / therapeutic use

Substances

  • Antifibrinolytic Agents
  • Tranexamic Acid