Investigation of the efficacy of systemic tranexamic acid in total hip arthroplasty

Total hip arthroplasty is a frequently performed procedure in the elderly population and is associated with a considerable risk of perioperative blood loss. This study aimed to compare the effects of tranexamic acid administered either as a single loading dose or as a loading dose followed by a maintenance infusion on intraoperative blood loss, perioperative transfusion requirements, hematological indices, and hemodynamic stability. A total of 102 patients who underwent total hip arthroplasty at the Department of Anesthesiology and Reanimation, Süleyman Demirel University Faculty of Medicine, were prospectively evaluated between September 2024 and September 2025. Patients were allocated into two groups: one group received only a loading dose of tranexamic acid, while the other received a loading dose followed by continuous maintenance therapy. Demographic characteristics, intraoperative blood loss, perioperative transfusion requirements, laboratory parameters, and hemodynamic data were compared between the groups. No statistically significant differences were observed between the two groups. However, patients who received maintenance therapy in addition to the loading dose exhibited less hematocrit decline, a smaller increase in lactate levels, and reduced blood product transfusion requirements. These findings suggest that the addition of a maintenance infusion may confer advantages in preserving tissue perfusion and maintaining hemodynamic stability. In conclusion, while a single loading dose of tranexamic acid appears sufficient in total hip arthroplasty, the addition of a maintenance infusion may further optimize perioperative outcomes. Larger trials with extended follow-up are warranted to clarify long-term benefits and assess potential late complications.