title: Additional intraarticular tranexamic acid further reduced postoperative blood loss compared to intravenous and topical bathed tranexamic acid in total hip arthroplasty: a retrospective sequential series study.
abstract: Topical tranexamic acid (TXA) administration has been described to be effective in decreasing blood loss in total hip arthroplasty (THA). The aim of this retrospective study was to evaluate whether topical intraarticular TXA administration in addition to intravenous (IV) and topical bathed TXA further reduces blood loss in THA patients.
  
  
  
  Four-hundred patients were enrolled in this sequential series study with two different phases during four different time periods. Patients were divided based on TXA usage and route of administration: those with and without IV TXA (IVTA-I and no-IVTA groups, respectively) and those with and without intraarticular TXA (TITA and IVTA-II groups, respectively). Both IVTA-II and TITA groups had IV TXA, and all four groups used topical bathed TXA. These four groups had 100 cases each. The primary outcomes were evaluated with total blood loss and postoperative hemoglobin level.
  
  
  
  The total blood loss was 1106 and 875 mL in the no-IVTA and IVTA-I groups, respectively (p < 0.05). Postoperative Hb was 10.9 and 11.51 g/dL in the no-IVTA and IVTA-I groups, respectively (p < 0.05). Total blood loss was 813 and 646 mL in the IVTA-II and TITA groups, respectively (p < 0.05). Intraarticular with IV and bathed TXA administration was more effective than IV and bathed TXA in reducing blood loss.
  
  
  
  This study suggests that the combined administration of topical intraarticular, bathed, and IV TXA was effective in reducing blood loss in THA patients.
authors.affiliation: Shonan Kamakura Joint Reconstruction Center, Kanagawa, Japan.
authors.forename: Nariaki
authors.initials: N
authors.lastname: Nakura
authors.affiliation: Shonan Kamakura Joint Reconstruction Center, Kanagawa, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hirakawa
authors.affiliation: Shonan Kamakura Joint Reconstruction Center, Kanagawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takayanagi
authors.affiliation: Shonan Kamakura Joint Reconstruction Center, Kanagawa, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.affiliation: Shonan Kamakura Joint Reconstruction Center, Kanagawa, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuji
authors.affiliation: Shonan Kamakura Joint Reconstruction Center, Kanagawa, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Tamaki
authors.affiliation: Shonan Kamakura Joint Reconstruction Center, Kanagawa, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Ochiai
authors.affiliation: Shonan Kamakura Joint Reconstruction Center, Kanagawa, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Mihara
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage*
chemical_list: D014148:Tranexamic Acid