title: Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty.
abstract: BACKGROUND
  This study was performed to test the effectiveness of topical tranexamic acid (TXA) in reducing blood loss in pelvic hemiarthoplasty surgeries compared with intravenous TXA, regarding the incidence of thromboembolic complications (deep vein thrombosis [DVT], pulmonary embolism (PE) and cerebrovascular stroke [CVS]).
  
  
  METHODS
  After obtaining institutional ethical approval 60 patients divided into three groups. Group A: Received intravenous TXA Group B: Received topical TXA Group C: Control group (placebo saline). All patients were received general anesthesia and post-operative bleeding, immediate and 24 h post-operatively, hemoglobin concentration, hematocrit, platelets and coagulation profile (prothrombin time, activated partial thromboplastin time and international normalized ratio) baseline, immediate and 24 h post-operatively. Thromboelastography was recorded baseline, immediate and 24 h post-operatively. Incidence of DVT, PE and CVS was recorded.
  
  
  RESULTS
  There was statistical significant elevation hemoglobin concentration and hematocrit in both Groups A and B, significant increase in blood loss in Group C, significant increase in number of patients receiving blood in Group C, there was a significant decrease in "r" and "k" times and a significant increase in maximum amplitude and α-angle in Group A, statistically significant increase in the incidence of thromboembolic events in the form of DVT, PE and CVS in Group A.
  
  
  CONCLUSIONS
  Topical TXA is effective in decreasing post-operative blood loss with possible side-effects of this route of administration.
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Walid Mohamed
authors.initials: WM
authors.lastname: Emara
authors.affiliation: Department of Anesthesia, National Cancer Institute, Cairo University, Giza, Egypt.
authors.forename: Khaled K
authors.initials: KK
authors.lastname: Moez
authors.affiliation: Department of Anesthesia, National Cancer Institute, Cairo University, Giza, Egypt.
authors.forename: Abeer H
authors.initials: AH
authors.lastname: Elkhouly
keywords: Hip arthroplasty; intravenous; topical; tranexamic acid