Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients.
BACKGROUND
A blood transfusion is a costly transplantation of tissue that may endanger the health for the recipient. Blood transfusions are common after total hip arthroplasty. The total saving potential is substantial if the blood loss could be reduced. Studies on the use of tranexamic acid have shown interesting results, but its benefits in total hip arthroplasty have not yet been resolved.


METHODS
100 patients receiving a total hip arthroplasty (THA) got a single injection of tranexamic acid (15 mg/kg) or placebo intravenously before the start of the operation. The study was double-blind and randomized. Total blood loss was calculated from the hemoglobin (Hb) balance. Volume and Hb concentration of the drainage was measured 24 h after the operation. Intraoperative blood loss was estimated volumetrically and visually.


RESULTS
The patients who received tranexamic acid (TA) bled less. The total blood loss was on average 0.97 L in the TA group and 1.3 L in the placebo group (p < 0.001). 8/47 (0.2) in the TA group were given blood transfusion versus 23/53 (0.4) in the placebo group (p = 0.009). Drainage volume and drainage Hb concentration were less in the TA group (p < 0.001 and p = 0.001). No thromboembolic complications occurred.


CONCLUSIONS
Considering the cost of blood and tranexamic acid only, use of the drug would save EUR 47 Euro per patient. We recommend a preoperative single dose of tranexamic acid for standard use in THA.
Johansson
Torsten
T
Division of Orthopaedics and Sports Medicine, Department of Neuroscience and Locomotion, Faculty of Health Sciences, University of Linköping, Sweden. Torsten.Johansson@lio.se
Pettersson
Lars-Göran
LG
Lisander
Björn
B
D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000191:economics; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011292:Premedication; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000191:economics
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid