Oral tranexamic acid is equivalent to topical tranexamic acid without drainage in primary total hip arthroplasty: A double-blind randomized clinical trial. Issue 167 (July 2018)

• Record Type: Journal Article
• Authors: Luo, Ze-Yu; Wang, Duan; Meng, Wei-Kun; Wang, Hao-Yang; Pan, Hui; Pei, Fu-Xing; Zhou, Zong-Ke
• Is Part Of: Thrombosis research. Issue 167(2018)
• Page Start: 1
• Page End: 5
• Publication Date: 2018-07
• Subjects: Tranexamic acid -- Topical -- Oral -- Total hip arthroplasty -- Blood loss -- Transfusion; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2018.04.026
• Languages: English
• ISSNs: 0049-3848

Abstract

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. Highlights: The first study to compare multiple doses of oral TXA with its topical administration in the setting of primary THA. The study also evaluated the impact of multiple doses of oral TXA on blood coagulation and fibrinolysis. The study confirmed the blood-sparing effect of multiple doses of oral TXA.