Tranexamic acid decreases risk of haematomas but not pain after hip arthroplasty.
BACKGROUND
Tranexamic acid decreases total blood loss after total hip arthroplasty (THA). Total blood loss is the sum of external bleeding and bleeding into tissues, i.e., haematomas. Haematomas may cause acute or even chronic postoperative pain.


OBJECTIVE
Tranexamic acid decreases haematomas, thereby diminishing postoperative pain after THA.


METHODS
In a retrospective matched case-control study, patients receiving tranexamic acid (15 mg/kg, before the incision and again at skin closure) were compared to controls not given tranexamic acid. Matching was on sex, surgeon, and peri-operative analgesics (ketamine, ketoprofen, pregabalin, and nefopam). Standardised protocols were used for anaesthesia, analgesia, and blood sparing. Haematoma volume was computed as the difference between total blood loss (estimated from the erythrocyte counts on days -1 and +5) and measured external blood loss. Patients were monitored from D0 to D7 then interviewed by telephone on D30, D90, and D180. To detect a 30%-decrease in the morphine dose at H24 (criterion 1) and D7 (criterion 2) and a 20% decrease in haematoma volume on D5 (criterion 3), the required numbers of patients were 90, 90, and 77, respectively; therefore, 95 patients were included.


RESULTS
Tranexamic acid decreased haematoma volume by 30% (351±254 mL versus 247±189 mL erythrocytes, P=0.002), had no effect on morphine consumption at H24 (12±11 mg versus 14±12 mg, P=0.346), increased morphine consumption on D7 (26±24 mg versus 35±36 mg, P=0.029), and had no effect on long-term pain.


CONCLUSIONS
After THA, tranexamic acid decreases haematoma volume without improving analgesia.


METHODS
3 (case-control study).
Pôle anesthésie réanimation SAMU, SAR2, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France. Electronic address: f.remerand@chu-tours.fr.
F
F
Remérand
M
M
Cotten
Y F
YF
N'Guessan
C
C
Couvret
P
P
Rosset
L
L
Favard
M
M
Laffon
J
J
Fusciardi
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
Haematoma; Postoperative pain; Total hip arthroplasty; Tranexamic acid