The effects of tranexamic acid application methods on the amount of bleeding in total hip arthroplasty

Purpose: Although total hip arthroplasty surgery has a high success rate among orthopaedic surgeries, it is a major surgery and hypovolemia/anaemia may develop as a result of the amount of intraoperative and postoperative blood loss. As a result of these conditions, the need for allogeneic blood transfusion (ABT) occurs due to blood loss. Each blood transfusion may increase complications such as immune reaction, infection, morbidity and mortality. Tranexamic acid (TXA) is an agent that can reduce blood loss and consequent blood transfusion by showing antifibrinolytic effect. Our aim in this study is to find the answer to the question of how to reduce possible blood loss and transfusion need in the most effective way by applying Tranexamic acid with different methods. Materials and Methods: Between January 2019 and June 2023, 164 patients (180 cases; the other hip of 16 patients was operated in another session) who underwent primary unilateral cementless total hip arthroplasty (THA) with the diagnosis of coxarthrosis admitted to the Orthopaedics and Traumatology Clinic of Ankara City Hospital were retrospectively included in the study. Patients in the study population were divided into 4 groups with equal numbers. Patients in whom the use of tranexamic acid was contraindicated, who were allergic to tranexamic acid, who had abnormal bleeding parameters and who did not attend at least 3-month follow-up for postoperative thromboembolic complications were excluded from the study. Tranexamic acid was administered intravenously (I.V.), orally and topically to the patients. Tranexamic acid was not administered to the placebo group, which was the control group. A negative pressure haemovac drain under the fascia was applied and clamped in all patient groups. No different method or a different pharmacological molecule was used to reduce the need for transfusion in any patient group. Preoperative blood counts, intraoperative bleeding, postoperative blood from the drain, postoperative blood counts, blood transfusion requirements, hospital stay and thromboembolic complications were compared in all patient groups. Results: There was no difference between the groups in the study between preoperative (p=0.276), postoperative day 15 (p=0.305) and postoperative month 1 (p=0.296) hb values. Significant differences were found between postoperative day 0 (p<0.05), day 1 (p<0.05) and day 2 (p<0.05) hb values. Significant differences were found between intraoperative bleeding amounts (p<0.05), postoperative day 0 (p<0.05) and day 1 (p<0.05) bleeding amounts from the drain, total bleeding amounts from the drain (p<0.05) and total bleeding amounts (p<0.05) between the groups. There were no significant differences between the groups in terms of blood transfusion requirement (p=0.318), mean hospital stay (p=0.162) and thromboembolic complications (p=0.332). Conclusion: It was observed that all tranexamic acid application methods significantly reduced intraoperative bleeding compared to the control group. Considering the total amount of bleeding from the drain, it was observed that both oral and topical Tranexamic acid application method provided less blood loss compared to the control group. When the total amount of bleeding was taken into consideration, it was observed that all tranexamic acid application methods provided significantly less blood loss compared to the control group. It was also observed that oral tranexamic acid administration method provided less blood loss than intravenous administration method. The groups were not significantly superior to each other in terms of blood transfusion requirement, hospital stay and thromboembolic complications. Considering that oral tranexamic acid administration method decreased the total amount of bleeding more effectively than the other groups and did not increase the need for blood transfusion, hospital stay and thromboembolic complications compared to the other groups, our study showed that oral tranexamic acid administration method is an effective and safe method. However, it is not sufficient to make a clear conclusion about the routes of administration of tranexamic acid in total hip arthroplasty and prospective comparisons with large participation are needed. Keywords: Blood Loss, Blood Transfusion, Total Hip Arthroplasty, Tranexamic Acid, Tranexamic Acid Application Methods