title: The effect of tranexamic acid on reducing blood loss in cementless total hip arthroplasty under epidural anesthesia.
abstract: Total hip arthroplasty (THA) is associated with high intraoperative and postoperative blood loss. Antifibrinolytic drugs have been used to minimize the potential risks of bleeding and blood transfusion. Studies on the effect of tranexamic acid on decreasing blood loss in THA have revealed interesting results, but most have focused on cemented THA. Yet its benefits in THA, especially in cementless THA, have not been proved. We conducted a prospective double-blind randomized controlled study on 64 patients who were candidates for cementless THA under epidural anesthesia between 2006 and 2008. Patients were randomly assigned into study and control groups. Patients in both groups were well matched regarding preoperative characteristics. Five minutes preoperatively 32 patients of the study and control groups received 15 mg/kg tranexamic acid or normal saline intravenously respectively. Our findings showed a significantly smaller decrease in 6- and 24-hour postoperative hemoglobin levels, less intraoperative and postoperative bleeding, and less need for allogenic blood transfusion in the tranexamic acid group. Our results also revealed a higher mean of 6- and 24-hour hematocrit level and shorter hospital stay in the tranexamic acid group compared to the control group, which were not statistically meaningful. In our study no thromboembolic event was seen; except 1 patient in the control group. Our study showed that administering tranexamic acid before the start of cementless THA under epidural anesthesia can reduce intraoperative and postoperative bleeding as well as need for blood transfusion.
authors.affiliation: Department of Orthopedics, Akhtar Orthopaedic Hospital, Tehran, Iran.
authors.forename: Seyyed Morteza
authors.initials: SM
authors.lastname: Kazemi
authors.forename: Faramarz
authors.initials: F
authors.lastname: Mosaffa
authors.forename: Alireza
authors.initials: A
authors.lastname: Eajazi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kaffashi
authors.forename: Laleh
authors.initials: L
authors.lastname: Daftari Besheli
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Bigdeli
authors.forename: Ramin Farhang
authors.initials: RF
authors.lastname: Zanganeh
mesh_terms: D000767:Anesthesia, Epidural; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D011292:Premedication / Q000379:methods*; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid