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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To explore the efficacy and safety of multiple-dose oral tranexamic acid (TXA) on blood loss following primary total hip arthroplasty (THA).
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).
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).
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
KeywordsTotal hip arthroplasty Tranexamic acid Oral Blood loss
This study was funded by the National Health and Family Planning Commission of the People’s Republic of China (CN) program (201302007).
Compliance with ethical standards
Conflict of interest
All authors declare no conflict of interest.
The trial was approved by the institutional review board and registered at the International Clinical Trial Registry (ChiCTR-IPR-17012266).
Informed consent was obtained from all individual participants included in the study.
- 1.Hogan CA, Golightly LK, Phong S, Dayton MR, Lyda C, Barber GR (2016) Perioperative blood loss in total hip and knee arthroplasty: outcomes associated with intravenous tranexamic acid use in an academic medical center. SAGE Open Med 4:205031211663702. https://doi.org/10.1177/2050312116637024 CrossRefGoogle Scholar
- 4.Xie J, Hu Q, Ma J, Huang Q, Pei F (2017) Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhanced-recovery primary total hip arthroplasty: a randomised clinical trial. Bone Joint J 99-b(11):1442–1449. https://doi.org/10.1302/0301-620x.99b11.bjj-2017-0488.r1 CrossRefGoogle Scholar
- 10.Kayupov E, Fillingham YA, Okroj K, Plummer DR, Moric M, Gerlinger TL, Della Valle CJ (2017) Oral and intravenous tranexamic acid are equivalent at reducing blood loss following total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am Vol 99(5):373–378. https://doi.org/10.2106/jbjs.16.00188 CrossRefGoogle Scholar
- 11.Luo ZY, Wang HY, Wang D, Zhou K, Pei FX, Zhou ZK (2017) Oral vs intravenous vs topical tranexamic acid in primary hip arthroplasty: a prospective, randomized, double-blind, controlled study. J Arthroplast. https://doi.org/10.1016/j.arth.2017.09.062
- 13.Sharrock N, Go G, Harpel PC, Ranawat CS, Sculco TP, Salvati E (1995) Thrombogenesis during total hip-arthroplasty. Clin Orthop Relat Res (319):16–27Google Scholar
- 16.Xie J, Ma J, Yao H, Yue C, Pei F (2016) Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss after primary total knee arthroplasty without tourniquet: a randomized clinical trial. J Arthroplast 31(11):2458–2464. https://doi.org/10.1016/j.arth.2016.04.034 CrossRefGoogle Scholar
- 25.Xie J, Ma J, Kang P, Zhou Z, Shen B, Yang J, Pei F (2015) Does tranexamic acid alter the risk of thromboembolism following primary total knee arthroplasty with sequential earlier anticoagulation? A large, single center, prospective cohort study of consecutive cases. Thromb Res 136(2):234–238. https://doi.org/10.1016/j.thromres.2015.05.014 CrossRefGoogle Scholar