The effect of systemic and local application of tranexamic acid on the amount of blood transfusion loss and blood loss amounts after total hip arthroplasty surgery

Aim: The results of systemic and local use of tranexamic acid (TEA) on the amount of blood loss and blood transfusion after primary total hip replacement were compared. Materials and methods: Between April 2014 and September 2015, 60 consecutive patients applied unilateral primary total hip repacement were included in the study.The patients with the history of serebrovasculer disease, MI, thromboemboli, MI, hematologic diseases and allergy to TEA were excluded. Patients were divided into three identical groups of 20 patients in each of them the first one was systemic, the other one was local TEA and the last one was the control group (TEA was not given). In group A, TEA infusion was given 15 mg/kg in 100 ml serum physiologic solution IV 20 minutes before operation. In group B, 2,5 gr TEA in 50ml SF was applied locally before the closure of joint capsule at the end of surgery and waited 5 minutes before closure. In group C, TEA was not applied. No other way to decrease the blood transfusion requirement and pharmacologic agent was not used in all the patients. Total hemovac drainage amounts, calculated total blood loss and the rate of allogenic blood transfusion were used as evaluation criteria between groups. Results: The 3 groups were homogeneous regarding the gender, age, ASA score and BMI. The mean Hb levels before surgery was 12.77 in group A, 12.63 in group B and 12.79 gr/dl in group C yielding no difference. The mean total hemovac drain amount was 498.75 in group A, 525.0 in group B and 636.25 ml in group C. The amount of postoperatif hemovac drainage amount was both lower in TEA groups than control group (p<0.01). There was no difference between local and systemic TEA goups (p=276). Allogenic blood was transfused only one patient in each TEA groups but 6 out of 20 (30%) patients were transfused in control group. One Pulmonary embolism occured in control group and the patient treated during hospitalisation. Conclusion: We established that the usage of TEA reduced the blood loss and the need for allogenic blood transfusion significantly after total hip replacement without any increase in thromboembolic complications. Systemic TEA decreasing the blood loss relatively more than local TEA might be preferred. Keywords: Total hip replacement, tranexamic acid, systemic, local, allogenic blood transfusion, hemoglobin, blood loss, antifibrinolytics.