Influence of single-dose intravenous tranexamic acid on total hip replacement : A study on transfusions, collateral complications, and readmissions.
BACKGROUND
To determine the effects of tranexamic acid (TXA) on transfusions in patients undergoing hip replacement with a hybrid or cementless prosthesis.


METHODS
A group of 172 consecutive patients aged 18 years or older who underwent elective hip replacement with uncemented or hybrid prostheses, undergoing surgery between January 2012 and January 2014 by the same primary surgeon and anesthesiologist, were retrospectively included. TXA (1 g) was administered immediately before incision in the TXA group. Primary variables included number of red blood cell transfusions and the influence of TXA for each type of prosthesis. Secondary variables included hematocrit at discharge, length of hospital stay, thrombosis or pulmonary embolism, seizures, and death.


RESULTS
Average transfusion was 1.53 units/patient in the control group compared to 0.6 units/patient in the TXA group (z = 6.29; U = 1640.5; p < 0.0001). TXA use was significantly correlated with the number of units transfused (p < 0.0001, 95% CI -1.24 to -0.68). Odds risk reduction for transfusion was observed during surgery (OR: 0.14; CI 0.06-0.29; p < 0.0001) and during the rest of hospital stay (OR: 0.11; CI 0.01-0.96; p = 0.046). Both hybrid and cementless prostheses that received TXA were transfused less than control groups (0.57 ± 1 vs. 1.7 ± 1 p < 0.01 and 0.65 ± 1 vs. 1.24 ± 1 p < 0.01). No difference was observed between the groups regarding adverse effects. Hematocrit values at discharge and length of hospital stay were similar between groups. No deaths were observed during hospital stay.


CONCLUSIONS
TXA reduced transfusions without increasing the prevalence of adverse effects. This reduction was observed during surgery and the following days of hospital stay for both for hybrid and cementless prosthesis.
Anesthesiology Department, Italian Hospital of Buenos Aires, Peron 4190, C1181ACH, Buenos Aires, Argentina.
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Fígar
Anesthesiology Department, Italian Hospital of Buenos Aires, Peron 4190, C1181ACH, Buenos Aires, Argentina. santiago.mcloughlin@hospitalitaliano.org.ar.
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Mc Loughlin
Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
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Slullitel
Transfusion Medicine and Hemotherapy Department, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
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Scordo
Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
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Buttaro
D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D001118:Argentina / Q000453:epidemiology; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011292:Premedication / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
Blood loss, postoperative; Cementless prosthesis; Efficacy; Hybrid prosthesis; Transfusions