title: Single-dose tranexamic acid for reducing bleeding and transfusions in total hip arthroplasty: A double-blind, randomized controlled trial of different doses.
abstract: BACKGROUND
  Tranexamic acid can be effective at decreasing blood loss and transfusion requirements associated with total hip arthroplasty (THA), but few studies have compared the efficacy of different intravenous dosing regimes. This double-blind, randomized controlled trial compared the ability of two doses of intravenous TXA (IV-TXA, 10 or 15mg/kg) to reduce bleeding and transfusions associated with THA.
  
  
  METHODS
  A total of 124 patients scheduled for THA were consecutively randomized 1:1:1 into three parallel arms: control (placebo), 10mg/kg IV-TXA and 15mg/kg IV-TXA.
  
  
  RESULTS
  The proportion of patients who experienced bleeding and required transfusions was significantly lower in the 15mg/kg IV-TXA group (1 of 42, 2.4%) than in the 10mg/kg IV-TXA group (8 of 39, 20.5%; P=0.012) and in the control group (10 of 38, 26.3%; P=0.002). In fact, this proportion was similar between the 10mg/kg IV-TXA and control groups (P=0.547). Ultrasound examination on postoperative day 3 revealed only one case of asymptomatic deep vein thrombosis (in the femoral vein) in the 10mg/kg IV-TXA group, which was managed by administering low-molecular-weight heparin. No cases of deep-vein thrombosis were observed in the other two groups. No cases of symptomatic pulmonary embolism were observed.
  
  
  CONCLUSIONS
  IV-TXA at 10mg/kg significantly reduced blood loss and mitigated the decrease in hemoglobin and hematocrit after THA, but it did not significantly reduce the need for transfusions. In contrast, a dose of 15mg/kg reduced both bleeding and transfusion requirements. Our results argue for a dose of 15mg/kg when using single-dose IV-TXA.
  
  
  METHODS
  Therapeutic Level I.
authors.affiliation: Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province 610041, China; Department of Orthopedic Surgery, Affiliated Hospital, Northwest University for Nationalities, Lanzhou, Gansu Province 730030, China. Electronic address: wangchangde76@163.com.
authors.forename: Changde
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province 610041, China. Electronic address: kangpd@163.com.
authors.forename: Pengde
authors.initials: P
authors.lastname: Kang
authors.affiliation: Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province 610041, China. Electronic address: 492385233@qq.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province 610041, China. Electronic address: 596681500@qq.com.
authors.forename: Chen
authors.initials: C
authors.lastname: Yue
authors.affiliation: Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province 610041, China. Electronic address: 154762995@qq.com.
authors.forename: Jinwei
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province 610041, China. Electronic address: pfxhuaxi@sina.com.
authors.forename: Fuxing
authors.initials: F
authors.lastname: Pei
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004311:Double-Blind Method; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014148:Tranexamic Acid
keywords: Bleeding; Deep vein thrombosis; Single dose; Tranexamic acid; Transfusion