Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement.
OBJECTIVE
This prospective randomized double-blind trial evaluates the efficacy of tranexamic acid (TA) to decrease blood losses and red blood cell transfusions in patients undergoing primary unilateral total hip replacement (THR).


METHODS
Forty ASA class I to III patients received either iv TA 10 mg.kg(-1) bolus before surgery plus a 1 mg.kg(-1).hr(-1) infusion until wound closure (Group TA) or a placebo (Group P). Red blood cell transfusions were administered according to a standardized protocol.


RESULTS
One patient of Group P was excluded because of an erroneous diagnosis at enrollment. Total measured blood losses (Group TA: 1308 +/- 462 mL vs Group P: 1469 +/- 405 mL), preoperative hemoglobin levels (Group TA: 130.4 +/- 12.5 g.L(-1) vs Group P: 131.4 +/- 12.8 vs g.L(-1)), and seven-day postoperative hemoglobin values (Group TA: 97.8 +/- 11.8 g.L(-1) vs Group P: 102.9 +/- 12.2 g.L(-1)) were similar. Autologous whole blood was available in five patients of Group P and seven patients of Group TA. Fewer patients in Group TA required red blood cells (Group TA: 6/20 vs Group P: 13/19; P = 0.026) and allogenic red blood cell transfusions (Group TA: 0/20 vs Group P: 8/19; P = 0.0012). The median number of transfused unit per patient was also significantly less in patients of Group TA (0 unit) than in Group P (2 units; P = 0.03).


CONCLUSIONS
TA did not change measured blood losses but reduced red blood cell transfusion requirements in patients undergoing primary unilateral THR.
Lemay
Erik
E
Department of Anesthesiology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada.
Guay
Joanne
J
Côté
Christiane
C
Roy
Alain
A
D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D001772:Blood Cell Count; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid