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The efficacy and safety of multiple-dose oral tranexamic acid on blood loss following total hip arthroplasty: a randomized controlled trial

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Abstract

Purposes

To explore the efficacy and safety of multiple-dose oral tranexamic acid (TXA) on blood loss following primary total hip arthroplasty (THA).

Methods

A total of 152 patients were randomized into three groups to receive 2 g of oral TXA two hours  pre-operatively (group A), or another bolus of 2 g of oral TXA four hours post-operatively (group B), or another three boluses of 2 g of oral TXA four, ten, and 16 hours post-operatively (group C). The primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and transfusion rate. The secondary outcomes were haemoglobin (Hb) and haematocrit (Hct) drop, the level of fibrinolysis parameters (fibrin degradation products, D-dimer), and complications (thrombotic diseases, stroke, cardiac infarction, and infection).

Results

The mean TBL and HBL in group C were lower than those in group A (p < 0.001 and p < 0.001) and group B (p = 0.012 and p = 0.029). The Hb drop on post-operative day one (POD1) and POD3 in group C was lower than those in group A (p < 0.001 and p = 0.029) and group B (p < 0.001 and p = 0.004). The difference was similar regarding Hct drop on POD3 (p < 0.001 and p = 0.014). Moreover, fibrin degradation products and D-dimer in group C were lower than in groups A and B on POD1 and POD3 (p < 0.001 and p < 0.001). The incidence of complications such as venous thromboembolism did not differ significantly among the three groups (p > 0.05).

Conclusions

Multiple boluses of oral TXA could further reduce blood loss, Hb and Hct drop, and restrain post-operative fibrinolysis in primary THA without increasing the risk of complications.

Level of Evidence I

Therapeutic study.

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Funding

This study was funded by the National Health and Family Planning Commission of the People’s Republic of China (CN) program (201302007).

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Author notes

  1. Qiang Huang and Fuxing Pei contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan Province, People’s Republic of China

    Guorui Cao, Qiang Huang, Zeyu Huang, Shaoyun Zhang, Zeyu Luo, Yiting Lei, Zongke Zhou & Fuxing Pei

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  1. Guorui Cao
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  2. Qiang Huang
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  3. Zeyu Huang
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Correspondence to Qiang Huang or Fuxing Pei.

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All authors declare no conflict of interest.

Ethical approval

The trial was approved by the institutional review board and registered at the International Clinical Trial Registry (ChiCTR-IPR-17012266).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cao, G., Huang, Q., Huang, Z. et al. The efficacy and safety of multiple-dose oral tranexamic acid on blood loss following total hip arthroplasty: a randomized controlled trial. International Orthopaedics (SICOT) 43, 299–305 (2019). https://doi.org/10.1007/s00264-018-3925-8

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  • DOI: https://doi.org/10.1007/s00264-018-3925-8

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