title: Combined use of intravenous and topical tranexamic acid following cementless total hip arthroplasty: a randomised clinical trial.
abstract: OBJECTIVE
  This study was designed to compare the efficacy and safety of the combined use of tranexamic acid (TXA) with the intravenous (IV) or local use alone in total hip arthroplasty (THA).
  
  
  METHODS
  210 patients were randomised to a IV group, a local group or a combined group. Participants received 1.5 g IV-TXA in the IV group, 3 g local TXA in the local group, or 1 g IV-TXA combined with 2 g local TXA in the combined group. The primary outcomes were total blood loss (TBL), maximum haemoglobin drop, and the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE).
  
  
  RESULTS
  TBL was (776.75 ± 188.95) ml in the combined group, which was significantly lower than in the IV group or the local group (p = 0.015, p = 0.001 respectively). Likewise, the mean values of maximum hemoglobin drop in the combined, IV, and local groups were 2.98 ± 0.78, 3.36 ± 0.78, and 3.89 ± 0.72 g/dL, respectively, with a significant intergroup difference (p&lt;0.001 for all). Asymptomatic DVT was detected in 1 patient of the IV group, and 2 patients of the combined group with the use of ultrasound. There were no episodes of PE, and no significant differences were seen between groups in terms of complications.
  
  
  CONCLUSIONS
  Combined use of intravenous TXA and local TXA in primary unilateral THA can effectively decrease total blood loss and increase postoperative haemoglobin levels without influencing complication rates. It is suggested that this combined TXA regimen is more effective in decreasing blood loss in cementeless THA than intravenous or local administration alone.
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu - China.
authors.forename: Jinwei
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu - China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu - China.
authors.forename: Chen
authors.initials: C
authors.lastname: Yue
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu - China.
authors.forename: Pengde
authors.initials: P
authors.lastname: Kang
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu - China.
authors.forename: Fuxing
authors.initials: F
authors.lastname: Pei
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002484:Cementation; D004359:Drug Therapy, Combination; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid