title: What is the optimal approach for tranexamic acid application in patients with unilateral total hip arthroplasty?
abstract: OBJECTIVE
  In the total hip arthroplasty (THA), the optimal administration route of tranexamic acid (TXA) remains controversial. This study was designed to investigate the impact of topical injection of TXA on blood loss during primary unilateral THA as well as short-term safety and adverse side effects compared with intravenous administration of TXA.
  
  
  METHODS
  In this study, 75 patients who underwent unilateral THA were randomly divided into 3 groups receiving intra-articular TXA (IA group), intravenous TXA (IV group) or no TXA (control group C). Blood loss, postoperative drainage, covert blood loss, total blood volume, the number of blood transfusions after surgery and transfusion rate, incidence of deep venous thrombosis and pulmonary embolism were recorded and evaluated in the three groups after 1 week and 1 month.
  
  
  RESULTS
  There were significant differences in the quantity of postoperative drainage, covert blood loss, total blood volume, the number of blood transfusions after surgery and transfusion rates between the three groups (P < 0.05), but blood loss during surgery showed no significant differences among the three groups (P > 0.05). In the IV group, 1 patient suffered from deep venous thrombosis of the lower limbs and in the C group, 2 patients suffered from superficial venous thrombosis of the lower limbs 2 and 4 days after surgery, respectively. In the IA group no complications occurred during the follow-up period.
  
  
  CONCLUSIONS
  Preoperative intravenous TXA and postoperative topical TXA significantly reduced postoperative blood loss and transfusion rates among the patients who underwent primary unilateral THA and the short-term safety was good. The data suggest that topical injection of TXA is safer and more effective, without postoperative complications.
authors.affiliation: Medical Center of Hip, Luoyang Orthopedic Traumatology Hospital, No. 82, South Qiming Road, 471002, Henan, China.|Orthopedics Hospital of Henan Province, Luoyang, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Medical Center of Hip, Luoyang Orthopedic Traumatology Hospital, No. 82, South Qiming Road, 471002, Henan, China.|Orthopedics Hospital of Henan Province, Luoyang, China.
authors.forename: Leilei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Medical Center of Hip, Luoyang Orthopedic Traumatology Hospital, No. 82, South Qiming Road, 471002, Henan, China.|Orthopedics Hospital of Henan Province, Luoyang, China.
authors.forename: Xianghao
authors.initials: X
authors.lastname: Ma
authors.affiliation: Medical Center of Hip, Luoyang Orthopedic Traumatology Hospital, No. 82, South Qiming Road, 471002, Henan, China.|Orthopedics Hospital of Henan Province, Luoyang, China.
authors.forename: Yudong
authors.initials: Y
authors.lastname: Jia
authors.affiliation: Medical Center of Hip, Luoyang Orthopedic Traumatology Hospital, No. 82, South Qiming Road, 471002, Henan, China.|Orthopedics Hospital of Henan Province, Luoyang, China.
authors.forename: Huichao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Medical Center of Hip, Luoyang Orthopedic Traumatology Hospital, No. 82, South Qiming Road, 471002, Henan, China.|Orthopedics Hospital of Henan Province, Luoyang, China.
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Medical Center of Hip, Luoyang Orthopedic Traumatology Hospital, No. 82, South Qiming Road, 471002, Henan, China. liuyouwenzhenggu@sina.com.|Orthopedics Hospital of Henan Province, Luoyang, China. liuyouwenzhenggu@sina.com.
authors.forename: Youwen
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Adverse effects; Orthopedics; Osteonecrosis of the femoral head; Randomized controlled study; Safety