Results after the application of tranexamic acid intravenous or intra-articular in the control of postsurgical bleeding
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ORIGINAL ARTICLE
Results after the application of tranexamic acid intravenous or intra‑articular in the control of postsurgical bleeding after total hip arthroplasty: a randomized controlled trial María del Sol Gómez‑Aparicio1 · Patricia Gómez‑Barbero1 · José Antonio Blas‑Dobón1 · Alfredo Villar‑Blanco1 · María Morales‑Suárez‑Varela2,3 · José Luís Rodrigo‑Pérez1 Received: 20 December 2019 / Accepted: 28 April 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Introduction A frequent complication after total hip arthroplasty is bleeding; to reduce it, intravenous or intra-articular tranexamic acid (TXA) is used. There is no evidence yet on which route of administration is better. Materials and method This was a prospective, controlled, randomized study in 2 arms between February 2017 and February 2019. In group A, 15 mg/kg intravenous TXA was administered and in group B 2 g intra-articular TXA. Haemoglobin and haematocrit values were evaluated at 24–72 h, also volume of drained blood, volume of blood lost, transfusions and complications. Results A total of 195 patients were included: 110 in group A and 85 group B. Haemoglobin dropped 3.10 ± 1.32 g/dl in 24 h and 3.63 ± 1.41 g/dl at 72 h in group A; the haematocrit dropped 8.38 ± 4.67% in 24 h and 15.40 ± 4.39% in 72 h. In group B, haemoglobin dropped 3.09 ± 1.40 g/dl in 24 h and 3.34 ± 1.23 g/dl in 72 h and haematocrit 9.75 ± 3.95% and 10.40 ± 3.72% in 24 and 72 h. No significant differences were found for haemoglobin values at 24 and 72 h and haematocrit at 24 h (p > 0.05); we did not obtain statistically significant differences in drainage, blood loss between groups or in the proportion of transfused. When stratifying the results by age, we obtained significant differences in the decrease in haemoglobin (p = 0.021) and haematocrit (p = 0.025) in patients > 65 years. Conclusions The different routes of administration of TXA in PTC have a similar effect in reducing post-operative bleeding without evidencing an increase in complications. Level of evidence I. Keywords Tranexamic acid · Intravenous route · Intra-articular route · Total hip arthroplasty · Transfusion
Introduction Total hip arthroplasty represents one of the most frequent surgeries for the treatment of hip pain secondary to arthrosis or avascular bone necrosis of the femoral head. One of the * María del Sol Gómez‑Aparicio [email protected] 1
Department of Orthopedic Surgery and Traumatology, Doctor Peset University Hospital, Avenida Gaspar Aguilar, 90, 46017 Valencia, Spain
2
Unit of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain
3
CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
most common complications of this surgery is bleeding during the operation that continues in the post-operative period [1, 2]. Investigation in hemodynamic management after this kind of surgery has increased exponentially in the recent years due to the association between a
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