Comparison of Perioperative Blood Loss with and without Tranexamic Acid in Hip Arthroplasty

  • Sanum Kashif Frontier Crops Hospital, Quetta, Pakistan
  • Zahid Khan Frontier Crops Hospital, Quetta, Pakistan
Keywords: Blood Loss, Hemoglobin Level, Hip Arthroplasty, Postoperative, Tranexamic Acid.

Abstract

Objective: To compare the perioperative blood loss in patients undergoing hip arthroplasty for femur neck
fractures with and without administering tranexamic acid before surgical incision.
Study Design: Comparative Interventional study.
Place and Duration of Study: The study was conducted at Orthopedic Department of Indus Hospital Karachi,
st th from 1 January to 30 June 2015.
Materials and Methods: After ethical committee approval, sixty patients, scheduled for hip arthroplasty were
included in this study. Patients were randomly allocated into two groups. Thirty patients in Group A (Tranexamic acid) treated with tranexamic acid with 15mg/kg dose in 10 ml syringe and Group B were given an equal volume of saline before surgery. In both groups, blood loss was calculated. The need for blood transfusion as well as the th amount of blood required was also noted. In both the groups, hematocrit was measured on 5 post-operative.
Results: A total of sixty patients (mean age 65.33±9.50 years), scheduled for hip arthroplasty, were included.
There were 26 (43.3%) male and 34 (56.7%) female patients. Patients were divided into two equal groups,
Group A (Tranexamic acid) and Group B (Normal Saline). Postoperative mean estimated blood loss was
significantly reduced in Group A than group B (203.8±141.81 vs. 281.6±130.31 p=0.031).
Conclusion: Tranexamic acid is a cost-effective and safe means of minimizing perioperative blood loss and
reduction in hemoglobin concentration in hip arthroplasty.

References

Iqbal MZ, Azeem M, Malik MR, Ch NA. Evaluation of Risk Factors of Hip Fractures; A Retrospective Study. Journal of Pakistan Orthopaedic Association. 2014 ; 26: 15-9.

Khan SH, Ara I, Raza S, Sipra S. Functional outcome of surgery in patients with acetabular fractures. J Ayub Med

Coll Abbottabad. 2013; 25: 60-3.

Tosounidis TH, Castillo R, Kanakaris NK, Giannoudis PV. Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them. Injury. 2015 ; 46: S3-11.

Hansson S, Rolfson O, Åkesson K, Nemes S, Leonardsson O, Rogmark C. Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients. Injury. 2015; 46: 2206-11.

Aslam KS, Niazi AK, Nabi O. Efficacy of tranexamic acid in reducing blood loss in total knee replacements. J Pak Med Assoc. 2015; 65: S210-4.

Wong S, Tang H, de Steiger R. Blood management in total hip replacement: an analysis of factors associated with allogenic blood transfusion. ANZ J Surg. 2015 ; 85: 461-5.

Saleh A, Small T, Pillai AL, Schiltz NK, Klika AK, Barsoum WK. Allogenic blood transfusion following total hip arthroplasty: results from the nationwide inpatient sample, 2000 to 2009. J Bone Joint Surg. American volume. 2014; 96: e155.

Roberts I, Prieto-Merino D, Manno D. Mechanism of action of tranexamic acid in bleeding trauma patients: an

exploratory analysis of data from the CRASH-2 trial. Crit Care. 2014; 18: 1-5.

Cole E, Davenport R, Willett K, Brohi K. Tranexamic acid use in severely injured civilian patients and the effects on outcomes: a prospective cohort study. Ann Surg Open. 2015; 261: 390-4.

Kayupov E, Fillingham YA, Okroj K, Plummer DR, Moric M, Gerlinger TL, et al. Oral and intravenous tranexamic acid are equivalent at reducing blood loss following total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2017; 99: 373-8.

Lei Y, Huang Q, Huang Z, Xie J, Chen G, Pei F. Multiple-dose intravenous tranexamic acid further reduces hidden blood loss after total hip arthroplasty: a randomized controlled trial. J Arthroplasty. 2018; 33: 2940-5.

Qi YM, Wang HP, Li YJ, Ma BB, Xie T, Wang C, et al. The efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis. J Orthop Translat. 2019; 19: 1-1.

Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Shores P, Mullen K, et al. The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis. J Arthroplasty. 2018; 33: 3083-9.

Jiang W, Shang L. Tranexamic acid can reduce blood loss in patients undergoing intertrochanteric fracture surgery: A meta-analysis. Medicine. 2019; 98: e14564.

Huang Z, Xie X, Li L, Huang Q, Ma J, Shen B, et al. Intravenous and topical tranexamic acid alone are superior to tourniquet use for primary total knee arthroplasty: a prospective, randomized controlled trial. J Bone Joint Surg Am. 2017; 99: 2053-61.

Othman Y, Melebeck F, Daubresse F. Tranexamic acid in joint replacement: a randomized trial comparing intravenous oral and topical routes. Acta Orthopædica Belgica. 2020; 86: 397-404.

Zhang P, He J, Fang Y, Chen P, Liang Y, Wang J. Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: a meta-analysis. Medicine. 2017; 96: e6940.

N u m k a n i s o r n S , C h a r e a n c h o l v a n i c h K, Pornrattanamaneewong C. Intravenous tranexamic acid before and after tourniquet use can reduce blood loss and blood transfusion after total knee arthroplasty. J Med Assoc Thai. 2016; 99: 1220-5.

Mukherjee M, Biswas C, Chatterjee S, Bandyopadhyay BK. Comparative study of efficacy of reduction of blood loss by tranexamic acid and epsilon aminocaproic acid for orthopedic femoral surgeries. Anaesth Pain & Intensive Care. 2016 ; 20: 417-21.

Digas G, Koutsogiannis I, Meletiadis G, Antonopoulou E, Karamoulas V, Bikos C. Intra-articular injection of

tranexamic acid reduce blood loss in cemented total knee arthroplasty. J Orthop Surg. 2015; 25: 1181-8.

Gómez-Barrena E, Ortega-Andreu M. Widespread of total knee arthroplasty perioperative blood management techniques based on tranexamic acid: barriers and opportunities. Ann Transl Med. 2015; 3: 299.

Gausden EB, Garner MR, Warner SJ, Levack A, Nellestein AM, Tedore T, et al. Tranexamic acid in hip fracture patients: a protocol for a randomised, placebo controlled trial on the efficacy of tranexamic acid in reducing blood loss in hip fracture patients. BMJ open. 2016; 6: e010676.

Lee C, Freeman R, Edmondson M, Rogers BA. The efficacy of tranexamic acid in hip hemiarthroplasty surgery: an observational cohort study. Injury. 2015; 46: 1978-82.

Tengberg PT, Foss NB, Palm H, Kallemose T, Troelsen A. Tranexamic acid reduces blood loss in patients with

extracapsular fractures of the hip: results of a randomised controlled trial. Bone Joint J. 2016; 98: 747-53.

Published
2021-12-31
Section
Original Article