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Tranexamic acid helps control blood loss vs. placebo in primary cementless THA
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NEW ORLEANS — Preoperative use of a single dose of tranexamic acid, which is derived from lysine, reduced blood loss in patients undergoing primary cementless total hip arthroplasty, according to researchers from India.
Rajesh Malhotra, MS, and colleagues from New Delhi, conducted a 50-patient prospective, randomized, double-blind study to investigate the effects on bleeding from tranexamic acid, a fibrinolysis inhibitor. Presenting results of the study at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons, here, he noted this approach was a viable alternative to other methods.
“We could conclude that injection of a single dose of tranexamic acid of 15 mg/kg just before surgery significantly reduces intraoperative and postoperative blood loss in patients undergoing primary cementless total hip arthroplasty without any increased risk of thrombotic events,” Malhotra said.
Most impact on postop blood loss
Fifteen minutes prior to incision, investigators administered a 15 mg/kg bolus of tranexamic acid in 25 patients randomized to receive the treatment in conjunction with uncemented total hip arthroplasty (THA). In the same way, the 25 patients randomized to the control group received the same amount of saline as placebo via intravenous injection.
Both groups received the same implants that the same surgeons implanted via the same approach, Malhotra said.
Among the study’s findings was a mean intraoperative blood loss in the tranexamic acid group of 410 ml compared with 615 ml in the placebo group. Mean postoperative blood loss in the placebo group was also more than double that in the tranexamic acid group at 490 ml compared to 210 ml.
Fewer patients in the tranexamic acid group (6 of 25) later needed a blood transfusion compared to patients in the placebo group requiring a transfusion (18 of 25).
Malhotra and colleagues also determined tranexamic acid was not associated with any greater risk of thrombus formation.
“We could not see any deep vein thrombosis with color Doppler and we could not demonstrate any elevation of D-dimer levels,” he said.
- Reference:
Malhotra R, Kumar V and Garg B. Use of tranexamic acid to reduce blood loss in primary cementless total hip arthroplasty. Paper #120. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.
