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

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.

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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.

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Correspondence to Jiang Pan.

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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

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Keywords

  • Hemostatic effect
  • Intravenous application
  • Local application
  • Total hip arthroplasty
  • Tranexamic acid