Single Dose Intravenous Tranexamic Acid Efficacy in Reducing Blood Loss in Total Hip Replacement

Intravenous Tranexamic Acid Efficacy in Total Hip Replacement

Authors

  • Muhammad Badar Ud Din Zafir Department of Orthopedic Surgery, Nishtar Medical University Hospital, Multan, Pakistan
  • Rana Shahid Waseem Ronaq Department of Orthopedic Surgery, Nishtar Medical University Hospital, Multan, Pakistan
  • Mazhar Ali Department of Orthopedic Surgery, Nishtar Medical University Hospital, Multan, Pakistan
  • Mukhtar Ahmad Tariq Department of Orthopedic Surgery, Tertiary Care Hospital, Nishtar II, Multan, Pakistan
  • Israr Ahmad Department of Orthopedic Surgery, Multan Medical and Dental College, Multan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i5.2584

Keywords:

Arthroplasty, Blood Loss, Total Hip Replacement, Tranexamic Acid

Abstract

Total Hip Replacement is a commonly performed procedure for Hip joint degeneration. Despite its hazards, blood transfusion has to be performed due to significant perioperative blood loss. The effects of pre-operative intravenous single-dose tranexamic acid in our population have been presented in this study. Objectives: To compare the mean blood loss during and after total hip replacement for hip osteoarthritis with or without a single dose of tranexamic acid. Methods: This quasi-experimental study was performed in the Orthopedic Surgery Department Unit II, Nishtar Medical University Hospital, Multan, from October 2022 to March 2024. In the experimental group, tranexamic acid (20mg/kg) was administered intravenously ten minutes before skin incision, while in the control group, no such drug was given. Preoperative and postoperative Hematocrit data were collected. THA was done as per standard protocol. The operative blood loss and blood transfusions were recorded and compared with the controls. Results: Among 60 patients, the mean age was 54.85 ± 12.23 years. Male were 19 (31.7%) and female were 41 (68.3%). BMI was 26.04 ± 3.48 Kg/m2. Mean age (p=0.746), mean BMI (p=0.633), age (p=0.417), gender (p=0.781) and BMI (p=0.749) were comparable in both groups. The estimated total loss of blood was significantly less in patients receiving intravenous tranexamic acid (1169.10 ± 191.92ml vs. 1730.07 ± 203.62ml; p<0.001) as compared to the control group. Conclusions: It was concluded that a pre-operative intravenous single dose of tranexamic acid decreased blood loss during surgery significantly in patients having total hip arthroplasty regardless of gender, age and BMI.

References

Atukorala I and Hunter DJ. A Review of Quality of Life in Elderly Osteoarthritis. Expert Review of Pharmaco-Economics and Outcomes Research. 2023 Apr; 23(4): 365-81. doi: 10.1080/14737167.2023.2181791.

Postler AE, Lützner C, Goronzy J, Lange T, Deckert S, Günther KP et al. When are patients with osteoarthritis referred for surgery? Best Practice and Research Clinical Rheumatology. 2023 Jun; 37(2): 101835. doi: 10.1016/j.berh.2023.101835.

Pathak N, Bovonratwet P, Purtill JJ, Bernstein JA, Golden M, Grauer JN, Rubin LE. Incidence, Risk Factors, and Subsequent Complications of Postoperative Hematomas Requiring Reoperation After Primary Total Hip Arthroplasty. Arthroplasty Today. 2023 Feb; 19: 101015. doi: 10.1016/j.artd.2022.08.008.

Zhao E, Zhu X, Zhou K, Liu Z, Lu H, Chen J et al. The Use of Intraoperative Cell Salvage in Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy for the Treatment of High Hip Dislocation: A Retrospective Cohort Study. BioMed Central Musculoskeletal Disorders. 2023 Apr; 24(1): 318. doi: 10.1186/s12891-023-06427-5.

Klein A, Agarwal S, Cholley B, Fassl J, Griffin M, Kaakinen T et al. A Review of European Guidelines for Patient Blood Management with A Particular Emphasis on Antifibrinolytic Drug Administration for Cardiac Surgery. Journal of Clinical Anesthesia. 2022 Jun; 78: 110654. doi: 10.1016/j.jclinane.2022.110654.

Prudovsky I, Kacer D, Zucco VV, Palmeri M, Falank C, Kramer R et al. Tranexamic Acid: Beyond Anti-fibrinolysis. Transfusion. 2022 Aug; 62: S301-12. doi: 10.1111/trf.16976.

Reale D, Andriolo L, Gursoy S, Bozkurt M, Filardo G, Zaffagnini S. Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta‐Analysis of Randomized Controlled Trials. BioMed Research International. 2021; 2021(1): 6961540. doi: 10.1155/2021/6961540.

Konig G, Hamlin BR, Waters JH. Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates in Total Hip and Total Knee Arthroplasty. The Journal of Arthroplasty. 2013 Oct; 28(9): 1473-6. doi: 10.1016/j.arth.2013.06.011.

Gross JB. Estimating Allowable Blood Loss: Corrected for Dilution. Anesthesiology. 1983 Mar; 58(3): 277-80. doi: 10.1097/00000542-198303000-00016.

Günther KP, Deckert S, Lützner C, Lange T, Schmitt J, Postler A. Total Hip Replacement for Osteoarthritis—Evidence-Based and Patient-Oriented Indications. Deutsches Ärzteblatt International. 2021 Oct; 118(43): 730. doi: 10.3238/arztebl.m2021.0323.

Shah A, Klein AA, Agarwal S, Lindley A, Ahmed A, Dowling K et al. Association of Anesthetists Guidelines: the Use of Blood Components And Their Alternatives. Anesthesia. 2025 Apr; 80(4): 425-47. doi: 10.1111/anae.16542.

Haratian A, Shelby T, Hasan LK, Bolia IK, Weber AE, Petrigliano FA. Utilization of Tranexamic Acid in Surgical Orthopedic Practice: Indications and Current Considerations. Orthopedic Research and Reviews. 2021 Oct: 187-99. doi: 10.2147/ORR.S321881.

PATCH-Trauma Investigators and the ANZICS Clinical Trials Group. Prehospital Tranexamic Acid for Severe Trauma. New England Journal of Medicine. 2023 Jul; 389(2): 127-36. doi: 10.1056/NEJMoa2215457.

Akti S, Zeybek H, Bilekli AB, Çelebi NÖ, Erdem Y, Çankaya D. The Effect of Tranexamic Acid on Hidden Blood Loss in Total Hip Arthroplasty. Joint Diseases and Related Surgery. 2022 Mar; 33(1): 102. doi: 10.52312/jdrs.2022.446.

Magill P, Hill JC, Bryce L, Martin U, Dorman A, Hogg R et al. Oral Tranexamic Acid for an Additional 24 Hours Postoperatively Versus A Single Preoperative Intravenous Dose for Reducing Blood Loss in Total Hip Arthroplasty: Results of A Randomized Controlled Trial (TRAC-24). The Bone and Joint Journal. 2021 Jul; 103(7): 1197-205. doi: 10.1302/0301-620X.103B7.BJJ-2020-2309.R1.

Vles GF, Corten K, Driesen R, Van Elst C, Ghijselings SG. Hidden Blood Loss in Direct Anterior Total Hip Arthroplasty: A Prospective, Double Blind, Randomized Controlled Trial on Topical Versus Intravenous Tranexamic Acid. Musculoskeletal Surgery. 2021 Dec; 105: 267-73. doi: 10.1007/s12306-020-00652-0.

Zheng C, Ma J, Xu J, Wu L, Wu Y, Liu Y et al. The Optimal Regimen, Efficacy and Safety of Tranexamic Acid and Aminocaproic Acid to Reduce Bleeding for Patients After Total Hip Arthroplasty: A Systematic Review and Bayesian Network Meta-Analysis. Thrombosis Research. 2023 Jan; 221: 120-9. doi: 10.1016/j.thromres.2022.11.010.

Zha GC, Zhu XR, Wang L, Li HW. Tranexamic Acid Reduces Blood Loss in Primary Total Hip Arthroplasty Performed Using the Direct Anterior Approach: A One-Center Retrospective Observational Study. Journal of Orthopedics and Traumatology. 2022 Dec; 23(1): 12. doi: 10.1186/s10195-022-00638-7.

Avcı Ö, Öztürk A, Çevik N, Akalın Y, Sağlıcak H, Şahin H. The Effect of Systemic Tranexamic Acid on Blood Loss and Blood Transfusion Requirement in Elective Total Hip Arthroplasty. Ortopedia Traumatologia Rehabilitacja. 2022 Oct; 24(5): 311-8. doi: 10.5604/01.3001.0016.1318.

Khanna G, Bajwa JS, Sharma R. The Role of Tranexamic Acid in Decreasing Intraoperative and Postoperative Blood Loss in Patients Undergoing Total Hip Replacement. International Journal of Orthopedics. 2021; 7(1): 528-32. doi: 10.22271/ortho.2021.v7.i1i.2535.

Khorram R, Borazjani R, Khavandegar A, Behjat M, Rahmanipour E, Vafadar R et al. The Efficacy of Tranexamic Acid in Perioperative Bleeding in Total Hip Arthroplasty Through Different Surgical Approaches: Systematic Review and Meta-Analysis. Journal of Orthopedics. 2024 Oct; 62: 112-121. doi: 10.1016/j.jor.2024.10.030.

Downloads

Published

2025-05-31
CITATION
DOI: 10.54393/pjhs.v6i5.2584
Published: 2025-05-31

How to Cite

Zafir, M. B. U. D., Ronaq, R. S. W., Ali, M., Tariq, M. A., & Ahmad, I. (2025). Single Dose Intravenous Tranexamic Acid Efficacy in Reducing Blood Loss in Total Hip Replacement: Intravenous Tranexamic Acid Efficacy in Total Hip Replacement. Pakistan Journal of Health Sciences, 6(5), 89–93. https://doi.org/10.54393/pjhs.v6i5.2584

Issue

Section

Original Article

Plaudit