title: Topical Tranexamic Acid is Equivalent to Targeted Preoperative Autologous Blood Donation in Total Hip Arthroplasty.
abstract: Topical tranexamic acid (TXA) was introduced to replace the previous targeted preoperative autologous blood donation (PABD) program. This study aims to analyze the efficacy of topical TXA compared with targeted PABD in anemic patients undergoing primary total hip arthroplasty (THA).
  
  
  
  Two thousand two hundred fifty-one patients underwent primary THA between 2009 and 2013 using targeted autologous blood donation for 280 anemic patients (12%; Hb <12.5 g/dL). One thousand nine hundred seventy-one nonanemic patients (88%; ≥12.5 Hb/dL) received no blood management intervention. Starting in 2014, 505 consecutive patients were operated using 3 grams of topical TXA and abandoning PABD. Ninety-one patients (18%) were anemic and 414 (82%) nonanemic.
  
  
  
  The utilization of topical TXA in anemic patients resulted in higher hemoglobin levels on the first postoperative day (P = .014), but not on the second postoperative day (P = .198) compared with PABD. There was no difference in allogeneic transfusion rates between both groups: 12% vs 13% (P = .848). In the nonanemic group, TXA significantly increased hemoglobin levels on the first postoperative day (P = .001) as well as on the second postoperative day (P < .001), and resulted in a reduction in allogeneic transfusion rates from 8% to 1%.
  
  
  
  The present study suggests that topical TXA is equivalent to PABD in anemic patients and reduces transfusion rates and increases Hb-levels in nonanemic patients.
authors.affiliation: Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Kasparek
authors.affiliation: Department of Orthopedic Surgery, University Ulm, Ulm, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Faschingbauer
authors.affiliation: Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Wenzel
authors.initials: W
authors.lastname: Waldstein
authors.affiliation: Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Cosima S
authors.initials: CS
authors.lastname: Boettner
authors.affiliation: Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Boettner
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia; D000933:Antifibrinolytic Agents / Q000191:economics / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D001782:Blood Donors; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000191:economics / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: anemia; blood management; total hip arthroplasty; tranexamic acid; transfusion