Blood-Sparing Efficacy of Oral Tranexamic Acid in Primary Total Hip Arthroplasty.

Background: Tranexamic acid (TXA) has been shown to be effective in reducing blood loss, hemoglobin drop, and blood transfusion in primary total hip arthroplasty. Most studies used intravenous form or topical form. This study was to assess the blood-sparing efficacy and safety of oral TXA in total hip arthroplasty.

Methods: Patients with primary total hip arthroplasty from 2012 to 2015 were recruited. Trial group with 1 gm of oral TXA 2 hours preoperatively, and 6 hours and 12 hours postoperatively was compared with the control group without drug. Outcome measures were intraoperative blood loss, drain output, observed total blood loss, actual total blood loss, hidden blood loss, hemoglobin drop, blood transfusion requirement, thromboembolic complications, cerebrovascular or cardiovascular complications, and mortality.

Results: After exclusion, 108 patients were included-54 in trial group and 54 in control group. There was no significant difference in the baseline characteristics. The trial group had significantly higher postoperative hemoglobin (10.3 vs 9.4 g/dL), lower hemoglobin drop (3.0 vs 4.1 g/dL), lower hidden blood loss (149 vs 354 mL), and lower actual total blood loss (847 vs 1096 mL). There was no significant difference in thromboembolic complications or mortality. There was also no periprosthetic infection or drug allergy.

Conclusion: Oral TXA is effective in blood sparing in terms of reduction in hemoglobin drop, hidden blood loss, and actual total blood loss. It is safe and is an alternative to the intravenous or topical form.