Recommendations for appropriate use of tranexamic acid in total hip arthroplasty

BACKGROUND: Tranexamic acid (TXA) has gained recent interest in orthopedics and trauma surgery because of its demonstrated benefit in several clinical trials. Prophylactic TXA is a safe, low-cost option to reduce bleeding in patients undergoing total hip replacement (THR), and its optimal dose and duration are unknown. Also, there is still no consensus as to the best form and dosages of the use of TXA. Hence the present study was carried out to determine the appropriate use of TXA, its dosage, timing, and recommendations for the best possible bleeding control in total hip arthroplasty. AIM AND OBJECTIVES: Present study was aimed to prove the efficacy of TXA in total hip arthroplasties when compared with a control group, to establish a criterion for the ideal use of TXA, and to identify possible complications. MATERIAL AND METHODS: A total of 238 adult patients receiving TXA undergoing replacement of hips since March 2015 were included in the study and divided randomly into four groups. Group one received a single dose of 500 mg TXA before the start of surgery (Preincision) over 10 minutes, group two received a 500 mg TXA 20 minutes prior to surgery in the operation room and just before the start of surgery (Preincision) over 10 minutes, group three received 500 mg TXA 20 minutes prior to surgery in the operation room and 500 mg just before the start of surgery (Preincision) over 10 minutes and then three hours post-surgery and group four (Control group) did not receive any TXA. Total blood loss was calculated using a formula considering hematocrit values and blood transfusions received. RESULT: Two hundred and thirty-eight adult patients were included in the study: 60 in group one, 59 in group two, 60 in group three and 59 in group four. All the groups had mean hemoglobin level above10 g/dL. Maximum benefit was observed in group three followed by group one and group two respectively with almost similar outcomes while group four did not show any benefits, thus demonstrating the beneficial effect of TXA regarding hemoglobin decrease postoperatively. CONCLUSION: The findings of the present study demonstrated that the use of TXA in THA reduced the incidence of perioperative bleeding and, consequently, a significant reduction in decrease in serum hemoglobin was observed in groups one, two, and three when compared to the group four control. Therefore, there was a reduction in the need for blood transfusion. Thus the maximum beneficial effect of TXA was observed in group three followed by group one and group two which had a similar outcome while group four did not show any benefits.