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Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates Associated With Primary Total Hip Arthroplasty

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Systemic tranexamic acid can decrease blood loss and rates of transfusion in patients undergoing total hip arthroplasty (THA). However, the efficacy of topical tranexamic acid in THA has only recently been characterized in a small number of studies.

Questions/purposes

The purpose of this study was to compare (1) the greatest hemoglobin decrease after surgery; (2) transfusion rates; and (3) symptomatic thromboembolic events among patients undergoing THA who did and did not receive topical tranexamic acid.

Methods

We retrospectively compared 135 patients (154 THAs) who received 10 mL 5% tranexamic acid added in a topical cocktail solution during surgery between January 2009 and July 2011 with 211 patients (234 THAs) who received only the topical cocktail solution (analgesic and antibiotic agent) between January 2005 and December 2008. Contraindications for the use of tranexamic acid included a documented history of a venous thromboembolic event, an allergy to tranexamic acid, thrombophilia, or a high risk of venous thromboembolism based on the guidelines of the American Academy of Orthopaedic Surgeons; the 135 patients who received it during that period represented 99.4% of the patients undergoing THA during that time. We compared changes in Hb, transfusion rates, estimated blood loss, surgical results, and complications between the groups. The transfusion threshold was the same, when the Hb values were < 10 g/dL. Patients were screened for thromboembolic disease if symptoms or signs appeared.

Results

Hb decreased less in the tranexamic acid group (1.87 ± 1.10 g/dL) than in the control group (2.2 ± 1.36 g/dL; p = 0.01) on the first postoperative day. The frequency of transfusion was lower in patients receiving tranexamic acid (17% as compared with 35% in the control group; p < 0.001). There was only one nonfatal pulmonary embolism in the control group during the study period.

Conclusions

Use of topical tranexamic acid in patients undergoing THA reduces postoperative bleeding and decreases blood transfusion rates. No increase in major complications was identified in patients managed with topical tranexamic acid. This retrospective study confirms the results of a smaller randomized trial on the same topic by another group.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan

    Chih-Hsiang Chang MD, Yuhan Chang MD, PhD, Dave W. Chen MD, PhD, Steve W. N. Ueng MD & Mel S. Lee MD, PhD

  2. College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Chih-Hsiang Chang MD, Yuhan Chang MD, PhD, Dave W. Chen MD, PhD, Steve W. N. Ueng MD & Mel S. Lee MD, PhD

  3. Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospital, 6, W. Sec., Jiapu Road, Puzi, Chiayi, Taiwan

    Mel S. Lee MD, PhD

Authors
  1. Chih-Hsiang Chang MD
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  2. Yuhan Chang MD, PhD
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  3. Dave W. Chen MD, PhD
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  4. Steve W. N. Ueng MD
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  5. Mel S. Lee MD, PhD
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Corresponding author

Correspondence to Mel S. Lee MD, PhD.

Additional information

One of the authors (MSL) is a consultant for Zimmer (Warsaw, IN, USA) without financial support and conflicts of interests in preparing this study.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Chang, CH., Chang, Y., Chen, D.W. et al. Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates Associated With Primary Total Hip Arthroplasty. Clin Orthop Relat Res 472, 1552–1557 (2014). https://doi.org/10.1007/s11999-013-3446-0

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  • DOI: https://doi.org/10.1007/s11999-013-3446-0

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